Medicare Shake-Up: Part B Drugs Enter PRICE Battle

January 30, 2026

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After years of Washington inflation and budget games, the Trump administration is moving to force price talks on 15 of Medicare’s costliest drugs—now including clinic-administered Part B medicines for the first time.

Quick Take

CMS selected 15 high-spend, single-source drugs for the third round of Medicare price negotiations, with talks starting in 2026 and new prices taking effect January 1, 2028.
The third cycle is the first to include Part B drugs, expanding negotiation beyond pharmacy-counter prescriptions into physician-administered medicines.
Drugmakers must decide whether to participate by February 28, 2026, under the negotiation program created by the 2022 Inflation Reduction Act.
Trump’s 2025 executive order directs HHS to boost transparency, prioritize high-cost drugs, and address the “pill penalty” that critics say distorts incentives.

CMS expands negotiations to Part B drugs, raising the stakes for 2028

CMS announced a new list of 15 drugs chosen for the third cycle of the Medicare Drug Price Negotiation Program, targeting high-cost medicines across Medicare Part D and, for the first time, Part B. Negotiations are scheduled for 2026, and the negotiated “maximum fair prices” would begin January 1, 2028. CMS also released a “top 50” list of eligible drugs, framing it as a transparency move for seniors and taxpayers watching runaway health costs.

CMS Administrator Dr. Mehmet Oz and Deputy Administrator Chris Klomp publicly emphasized that the selection process weighs spending levels alongside clinical benefit, alternative treatments, and unmet medical need. The timeline matters: seniors should not expect immediate relief from this third cycle, because the discounts do not apply until 2028. Still, the inclusion of Part B drugs signals a broader federal reach into the most expensive corners of Medicare, where many bills flow through clinics and hospital systems.

White House Announces 15 New Drugs for Medicare Price Negotiation Program

The drugs selected include some of the medications on which Medicare spends the most money. pic.twitter.com/sccbome69v

— NTD (@NTD_Live) January 28, 2026

How the program works—and why it’s politically complicated

The negotiation program itself originated in the 2022 Inflation Reduction Act, a Biden-era law that Trump’s second administration is now operating and reshaping rather than repealing. The framework focuses on high-spend, single-source brand drugs without generic competition. CMS selects eligible drugs, then negotiates prices with manufacturers under a statutory process. That structure has drawn criticism from industry groups worried about innovation, while patient advocates argue it finally challenges pricing power built into federal purchasing.

Two earlier cycles set the template. The first cycle covered 10 drugs, with negotiated prices scheduled to take effect in 2026; cited estimates project roughly $6 billion in annual Medicare savings and about $1.5 billion in annual beneficiary out-of-pocket savings. The second cycle involved 15 Part D drugs with agreements signed in March 2025; CMS later announced discounts ranging from 38% to 84% off 2024 list prices, with estimates of about $12 billion in annual Medicare savings and $685 million in savings for beneficiaries when those prices take effect in 2027.

The Trump-era shift: more transparency, less distortion, and a tighter focus on costs

Trump’s Executive Order 14273, issued April 15, 2025, directed HHS to improve how the negotiation program is implemented. The order emphasizes transparency and prioritizing high-cost drugs, while also addressing the so-called “pill penalty”—the policy imbalance where small-molecule drugs can face negotiation earlier than biologics. Policy analysts have argued that this timing difference can warp investment decisions, potentially steering research away from certain drug types regardless of patient need.

This is where the politics gets real for conservatives: the same federal machinery that can pressure prices downward can also grow into a permanent price-setting bureaucracy if Congress and future administrations keep expanding it. The Trump administration’s stated approach, based on the executive order and CMS messaging, is to apply pressure where costs are highest while adding sunlight to the selection process. That transparency push—such as publishing the top 50 eligible drugs—helps voters and lawmakers see what’s being targeted and why.

What seniors can expect next—and what to watch in 2026

Drug companies have until February 28, 2026, to decide whether to participate in the third-cycle negotiations. The government’s leverage comes from the law’s structure, which sets penalties and consequences for noncompliance, meaning participation is not a casual choice for manufacturers. CMS says it will consider factors like clinical value, available alternatives, and R&D costs as negotiations proceed. For seniors, the practical takeaway is timing: the third-cycle prices land in 2028, not this year.

Congressional and budget dynamics could still shape the program’s reach. Research cited by analysts points to 2025 budget reconciliation changes (HR 1) that narrowed aspects of negotiation policy and could increase Medicare spending by more than $5 billion, highlighting how quickly Washington can give with one hand and take with the other. If the administration can lock in durable savings without drifting into broader government control, it will strengthen the case that “America First” reforms can deliver relief to seniors without the waste and mismanagement voters associate with the prior era.