More medication to see Medicare price cuts in 2027
The injectable drug Ozempic is pictured. Ozempic is one of several medications that will be less expensive for Medicare users this year. AP file photo
The injectable drug Ozempic is pictured. Ozempic is one of several medications that will be less expensive for Medicare users this year. AP file photo
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Question: I paid so much for my Trelegy this year, will I have to pay that much next year too?
Answer: The good news is no, Medicare enrollees will not pay as much for Trelegy as well as 16 other medications in 2027. Remember that Centers for Medicare Services (CMS) announced that in 2027 there will be more medications that are now at a negotiated price. These medications are all brand name medications.
The last year's list includes: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbrucia, Stelara, and Fiasp and Novolog Insulins.
In 2027 the list is longer and is the following: Ozempic, Rybelsus, Wegovy, Trelegy Ellipta, Xtandi, Pomalyst, Ofev, Ibrance, Linzess, Calquence, Austedo, Austedo XR, Breo Ellipta, Xifaxan, Vraylar, Tradjenta, Janumet, Janumet XR, Otezla and Otezla XR.
This list is going to have a positive impact on many Medicare households.
Now I will give you some examples with approximate pricing. In 2026 your Trelegy Ellipta retails for $654 and once you have met your deductible, you likely paid a 25% cost share at the pharmacy which was $163.50. In 2027 that same Trelegy Ellipta has a negotiated price of approximately $175 and therefore your 25% cost share is $43.75. Now, it will take longer to get through your $700 deductible, but you will be spending significantly LESS in 2027.
Let's review some others, Ozempic in 2026 retails for $959 and your 25% would be $239.75. In 2027, your Ozempic has a negotiated price of approximately $274 and therefore your 25% cost share is $68.50. Linzess in 2026 retails for $539 and your 25% cost share would be $134.75. In 2027, Linzess has a negotiated price of approximately $136 and therefore your cost share would be $34. Otezla in 2026 retails for $4,722 and your 25% would be $1,180.50. In 2027, Otezla has negotiated a price of approximately $1,650 and therefore your 25% would be $412.50.
You can see with just these four examples of the medications in this program, that those buying these medications will save significantly in 2027. Now in 2026 if you were taking one or more of these medications, you likely met the maximum out of pocket (MOOP) in 2026 of $2,100. When this happens you have moved into the catastrophic phase of Part D coverage and all your medications are reduced to $0 copay for the remainder of the year. In 2027 that MOOP goes up to $2,400 to reach the catastrophic phase of Part D coverage. For many taking one or more of the price controlled medications, they will likely not reach that MOOP level because they are not paying as much at the pharmacy as they have in years past.
That is good news for many seniors. As medications become available in a generic version, they usually become less expensive. That means in coming years we will see significant cost savings on the generic equivalent for sure and likely the brand name price will drop as well. The first year a medication is offered generically, we usually see our Part D plans not cover the generic equivalent as it is too new and was not added to their formulary, so it can take a couple of years before we see significant price drops in these situations.
Before you request the generic alternatives be sure that your Part D plan is covering the generic. That rule sometimes changes mid-year, so what you weren't allowed to get in January as a generic substitute, you may be able to get later in the year. You can work with your physician as your situation changes.
I am excited as we have seen significant cost savings for all individuals on Medicare Part D in the last couple of years, at least at the pharmacy. But this means the insurance companies are having to pay more of your medication costs and therefore tend to increase the premiums that you pay for the insurance coverage. But overall I believe it is a significant savings and should be celebrated.
Happy Insurance Season! Be sure to evaluate your coverage for the new year and hopefully you will see reduced overall costs on your medications.
Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.