Trulicity, Botox Headline Drugs Included in the Third Cycle of Medicare Price Negotiations

CMS has announced that the new cycle of drug price negotiations by Medicare will include big-name drugs for diabetes and HIV/AIDS, as well as Botox injections.^1,2 The 15 high-cost prescription drugs included in the price negotiations are primarily covered by Medicare Part D but also feature for the first time some drugs covered under Medicare Part B.

The new cycle of negotiations will be the third such cycle since the Inflation Reduction Act (IRA) of 2022 was passed. The IRA allows for the secretary of HHS to negotiate prices of drugs directly with pharmaceutical companies.³ Previously, all prescription drugs that had their prices negotiated had been those covered by Medicare Part D (drug coverage). However, starting with this round of negotiations, drugs covered by Medicare Part B (medical insurance, including some provider-administered drugs) can also be included. The prices resulting from the current round of negotiations will not take effect until 2028.²

The 15 drugs that have been announced as part of the negotiations cover various disease states and include:

• Umeclidinium/vilanterol (Anoro Ellipta; GSK)
• Bictegravir/emtricitabine/tenofovir (Biktarvy; Gilead Sciences)
• OnabotulinumtoxinA (Botox and Botox Cosmetic; AbbVie)
• Certolizumab pegol (Cimzia; UCB)
• Secukinumab (Cosentyx; Novartis)
• Vedolizumab (Entyvio; Takeda Pharmaceuticals)
• Apalutamide (Erleada; Johnson & Johnson)
• Ribociclib (Kisqali; Novartis)
• Lenvatinib (Lenvima; Eisai)
• Abatacept (Orencia; Bristol-Myers Squibb)
• Brexpiprazole (Rexulti; Otsuka)
• Dulaglutide (Trulicity; Eli Lilly)
• Abemaciclib (Verzenio; Eli Lilly)
• Tofacitinib (Xeljanz and Xeljanz XR; Pfizer Inc.)
• Omalizumab (Xolair; Genentech)

Patients are familiar with dulaglutide under its brand name of Trulicity, as it is primarily used to treat type 2 diabetes. After semaglutide was included in last year’s negotiations, dulaglutide’s inclusion marks the second glucagon-like peptide-1 agent targeting diabetes to undergo price negotiations for Medicare. Bictegravir/emtricitabine/tenofovir is primarily used as an antiretroviral therapy for HIV, making it the first HIV drug to have its price negotiated under the IRA.⁴

OnabotulinumtoxinA is also a high-profile drug getting the nod for price negotiations. The injection is primarily used to treat chronic migraines, overactive bladder, spasticity, and other movement disorders, beyond its more commonly known usage as a cosmetic drug.

Psoriatic arthritis, psoriasis, prostate cancer, breast cancer, Crohn disease, thyroid cancer, asthma, major depressive disorder, schizophrenia, chronic obstructive pulmonary disease, liver cancer, and kidney cancer are among the other disease states and conditions that are targeted through the 15 drugs selected, with approximately 1.8 million people on Medicare Part B or Part D using these drugs between November 2024 and October 2025.¹ Total prescription drug spending was approximately $27 billion in these 15 drugs, which was about 6% of all spending for Part B and Part D.

The negotiations will also include the renegotiation of the price of linagliptin (Tradjenta; Eli Lilly), which is primarily used for type 2 diabetes. This renegotiation is due to a refinement based on public feedback, according to CMS.²

The drug price negotiations aim to make treatments more accessible for those 65 years and older. Although these negotiated prices will not be in effect until 2028, the promise of easier access to life-saving treatments, such as those that address HIV and various cancers, and even cosmetic and quality-of-life treatments, such as those for psoriasis, has the potential to make differences in the overall prognosis of these conditions in older patients while also holding drug companies to making their treatments affordable and accessible.

However, some Democrats have criticized the list of drugs made available for price negotiation. Sen Ron Wyden (D, Oregon) noted that pembrolizumab (Keytruda; Merck) and nivolumab (Opdivo; Bristol Myers Squibb), 2 popular cancer drugs that are both expensive for patients, were not included in the list of drugs released by CMS.

“Two of the best-selling and most expensive cancer drugs—Keytruda and Opdivo—are not on this list thanks to Trump and congressional Republicans… As a direct result of the Big Ugly Bill, passed with only Republican votes and signed into law by Trump, seniors fighting cancer will be forced to pay more for life-saving drugs," said Wyden.⁵

CMS Administrator Mehmet Oz, MD, MBA, was more positive regarding the effect that these drug price negotiations will have on patients across the country.

“Under President Trump’s leadership, CMS is taking strong action to target the most expensive drugs in Medicare, negotiate fair prices, and make sure the system works for patients—not special interests. This approach delivers real savings while strengthening accountability across the program,” Oz said in a statement.¹

References

1. CMS announces selection of drugs for third cycle of Medicare drug price negotiation program, including first-ever Part B drugs. News release. CMS. January 27, 2026. Accessed January 28, 2026. https://www.cms.gov/newsroom/press-releases/cms-announces-selection-drugs-third-cycle-medicare-drug-price-negotiation-program-including-first
2. Weixel N, Choi J. Medicare picks Botox and Trulicity for latest round of negotiations. The Hill. January 27, 2026. Accessed January 28, 2026. https://thehill.com/newsletters/health-care/5709778-medicare-picks-botox-and-trulicity-for-latest-round-of-negotiations/
3. Cubanski J. FAQs about the Inflation Reduction Act’s Medicare Drug Price Negotiation Program. January 23, 2025. Accessed January 28, 2026. https://www.kff.org/medicare/faqs-about-the-inflation-reduction-acts-medicare-drug-price-negotiation-program/
4. Selected drugs and negotiated prices. CMS. Updated January 27, 2026. Accessed January 28, 2026. https://www.cms.gov/priorities/medicare-prescription-drug-affordability/overview/medicare-drug-price-negotiation-program/selected-drugs-negotiated-prices
5. Wyden Statement on Selection of Medicare Negotiation Drugs. News release. January 27, 2026. Accessed January 28, 2026. https://www.finance.senate.gov/ranking-members-news/wyden-statement-on-selection-of-medicare-negotiation-drugs