Georgia Medicare Drug Price Negotiation: First 10 Drugs (2026)

For Georgia Medicare beneficiaries, the Medicare Drug Price Negotiation Program cut the price of ten high-spend Part D drugs on January 1, 2026. A Georgia retiree taking Eliquis, for example, saw her monthly coinsurance fall by more than half when the first round of negotiated prices reached the pharmacy counter. This guide explains what changed, and what it saves a Georgia Part D beneficiary.

Georgia Medicare Drug Price Negotiation at a glance

• Federal authority: Section 11401 of the Inflation Reduction Act of 2022 (Public Law 117-169) created the Medicare Drug Price Negotiation Program at Section 1191 et seq. of the Social Security Act (42 USC 1320f). IRC Section 5000D imposes a steep excise tax on manufacturers who refuse to negotiate, effectively forcing participation.
• Effective date: The first 10 negotiated prices took effect January 1, 2026. The next 15 Part D drugs follow in 2027, 15 combined Part B and Part D drugs in 2028, and 20 additional drugs per year thereafter.
• First 10 drugs (2026): Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog.
• Selection criteria: The top 50 highest-spend Part D drugs without generic or biosimilar competition. Small-molecule drugs become eligible 9 years after FDA approval; biologics at 11 years.
• For Georgia families: Lower per-fill cost-sharing at the pharmacy counter, and slower accumulation toward the $2,100 out-of-pocket cap. GeorgiaCares (1-866-552-4464) provides free counseling on how the negotiated prices affect your plan.1,2
• Constitutional litigation: Merck, Bristol-Myers Squibb, Boehringer Ingelheim, AstraZeneca, Novartis, Novo Nordisk, and Janssen filed federal lawsuits. Courts have largely sided with the government; the program continues.

Federal framework for Georgia Medicare drug price negotiation

For nearly two decades after Medicare Part D launched in 2006, the federal government was prohibited by statute from negotiating drug prices with pharmaceutical manufacturers. The "non-interference clause" at Section 1860D-11(i) of the Social Security Act, enacted as part of the Medicare Modernization Act of 2003 (MMA, Public Law 108-173), expressly forbade the Secretary of HHS from interfering in negotiations between drug manufacturers, pharmacies, and Part D plans. Specifically, it barred HHS from:

• Interfering in negotiations between drug manufacturers, pharmacies, and Part D plans
• Requiring a particular formulary or instituting a price structure for drug reimbursement
• Establishing a specific formulary

This "non-interference clause" was a deliberate design choice in 2003: Congress wanted Part D to operate through competing private plans negotiating prices through pharmacy benefit managers (PBMs), rather than having the government set prices directly as in Medicaid (where the Medicaid Drug Rebate Program at Section 1927 SSA establishes formula-based rebates). The result was a system in which Medicare beneficiaries received some discounts through private plan negotiations, but the federal government, the single largest payer, did not directly negotiate. Medicare frequently paid far more than other developed nations paid for the same medications.

The Inflation Reduction Act of 2022 (IRA, Public Law 117-169), signed by President Biden on August 16, 2022, carved out an exception to the non-interference clause for "selected drugs" under a new Negotiation Program. Section 11401 of the IRA created Sections 1191 through 1198 of the Social Security Act (42 USC 1320f), establishing the legal framework. The non-interference clause continues to apply to all other Part D drugs not selected for negotiation.

Section 1191 SSA: Establishment of the program

Section 1191 establishes the Medicare Drug Price Negotiation Program and authorizes HHS to:

• Designate selected drugs each year from the qualifying-drug pool
• Negotiate Maximum Fair Prices (MFPs) with manufacturers
• Require manufacturers to provide MFP-eligible beneficiaries access at the MFP through dispensing entities
• Publish information about the program

Section 1192 SSA: Selection criteria

Section 1192 defines which drugs are eligible for negotiation:

• A "negotiation-eligible drug" is a qualifying single-source drug among the top 50 highest-spend Part D drugs
• Orphan drugs (a single FDA-approved indication for a rare disease) are excluded
• Plasma-derived products are excluded
• Low-spend drugs below the statutory annual Part D spending floor are excluded
• Drugs less than 9 years past FDA approval (small molecule) or 11 years (biologic) are excluded

CMS publishes the list of selected drugs annually: 10 drugs for 2026 (announced August 2023, MFPs published August 2024), 15 additional Part D drugs for 2027 (announced January 2025), 15 additional combined Part B and Part D drugs for 2028, and 20 additional drugs per year for 2029 and beyond.

Section 1193 SSA: Negotiation process

The negotiation process unfolds across roughly two years: CMS publishes the selected-drug list, makes an initial offer to the manufacturer, receives a counter-offer, concludes negotiation, and publishes the MFP, which then takes effect at the pharmacy counter the following January. For the 10 drugs effective January 1, 2026, this timeline ran from August 2023 (selection) through August 2024 (MFP publication) to January 2026 (effective date).

Section 1194 SSA: Maximum Fair Price (MFP) calculation

The MFP cannot exceed the lower of two ceilings. Ceiling A is the drug's non-Federal Average Manufacturer Price (AMP) multiplied by an applicable percentage based on time since FDA approval, set by statute at 42 USC 1320f-3:

Ceiling B is an "international reference price" comparison and other factors specified in statute. CMS applies the methodology and publishes the MFP, which is "fair" by statutory definition. Many manufacturers and economists disagree, but the methodology is binding under the law.

IRC Section 5000D: Excise tax on non-participating manufacturers

To enforce participation, Congress added Section 5000D to the Internal Revenue Code. A manufacturer that does not enter into a Negotiation Program agreement faces an excise tax on its US sales of the drug that escalates the longer it stays out of compliance, as set by IRC Section 5000D:

At the top of that schedule the tax is, in practice, prohibitive: most manufacturers would lose more from the tax than from accepting the MFP, so the structure compels participation through economic force rather than direct mandate. The constitutionality of this enforcement mechanism is at the heart of the manufacturer lawsuits discussed later in this guide.

The first 10 selected drugs and their Maximum Fair Prices

CMS announced the first 10 selected drugs in August 2023 and published the negotiated Maximum Fair Prices on August 15, 2024. The MFPs took effect at the Part D pharmacy counter on January 1, 2026, the program's initial price applicability year. Across the 10 drugs, the negotiated prices represent discounts of 38% to 79% off the drugs' 2023 list prices, and about 9 million people with Medicare used these 10 drugs in 2023. The table below shows the 10 drugs with their 2023 list prices before negotiation and their 2026 Maximum Fair Prices, as published by CMS.3

Source: CMS, Medicare Drug Price Negotiation Program negotiated prices, published August 2024 (cms.gov/inflation-reduction-act). List prices are approximate 30-day equivalents and vary by dose and pharmacy.

For Georgia Medicare beneficiaries, the practical impact is most concentrated on the cardiovascular and diabetes drugs (Eliquis and Xarelto for anticoagulation; Jardiance, Januvia, and Farxiga for diabetes; Entresto for heart failure), because these conditions are highly prevalent among older adults. The biologic and specialty drugs (Enbrel, Imbruvica, Stelara) affect fewer beneficiaries but deliver much higher dollar savings per affected person.

How Georgia Medicare drug price negotiation reaches the pharmacy counter

The Maximum Fair Price is not just a number on a CMS website. It changes how Part D plans, pharmacies, and beneficiaries transact at the counter. Here is how the flow works.

At the manufacturer level

Each participating manufacturer signs an agreement with HHS committing to:

• Provide MFP access to MFP-eligible individuals (Medicare beneficiaries enrolled in Part D)
• Process MFP discounts through the Medicare Transaction Facilitator (MTF), a CMS-administered claims processing system launched in January 2026
• Publish the MFP transparently per Section 1196
• Refrain from raising other prices or restricting access in retaliation

At the Part D plan level

Part D plans (standalone PDPs and Medicare Advantage Prescription Drug plans, or MA-PDs) continue to negotiate with manufacturers for additional rebates above the MFP. Plans must charge beneficiaries cost-sharing based on the MFP rather than the list price, maintain the drug on formulary if it was previously covered (Section 1192 includes anti-discrimination provisions), and process claims through the MTF for rebate flow.

At the pharmacy level

Pharmacies fill prescriptions and submit claims to plans as before. The pharmacy receives full reimbursement from the plan (the plan recoups the difference via manufacturer rebates through the MTF), collects beneficiary cost-sharing based on MFP-driven pricing, and provides the drug to the beneficiary. Georgia pharmacies, including major chains (CVS, Walgreens, Walmart, Kroger, Publix), regional chains, and independents, have been integrated into the MTF system. Some independent Georgia pharmacies raised cash-flow concerns during the MTF rollout, but most processing is now standardized.

At the beneficiary level

The Georgia Medicare beneficiary experiences the MFP as reduced cost-sharing at the pharmacy counter. In the initial coverage phase, a Part D enrollee pays 25% coinsurance, so a lower Maximum Fair Price lowers the monthly out-of-pocket cost on a negotiated drug; the per-drug figures appear in the quick-reference table below. What you actually pay still depends on your plan's benefit design: the Maximum Fair Price lowers the drug's price, not necessarily your copay directly.1,3

Because each fill costs less, spending accumulates toward the $2,100 annual out-of-pocket cap more slowly, so a beneficiary taking a single negotiated drug may not reach the cap at all in a year.1

Interaction with the $2,100 out-of-pocket cap under IRA Section 11201

The Medicare Drug Price Negotiation Program (IRA Section 11401) and the $2,100 annual out-of-pocket cap (IRA Section 11201) are complementary cost-saving reforms that operate independently. Both protect beneficiaries; together they protect more. A Georgia beneficiary also pays the plan's Part D deductible (up to $615 in 2026) before coinsurance begins.4

Lower per-fill cost slows accumulation toward the cap

For beneficiaries on a single negotiated drug, a lower MFP reduces monthly out-of-pocket cost and slows the rate at which the beneficiary reaches the $2,100 cap. Many beneficiaries on a single negotiated drug never reach the cap.1

Multi-drug regimens still benefit from the cap

For beneficiaries on multiple high-cost drugs (for example, a heart-failure-with-diabetes patient on Eliquis plus Jardiance plus Entresto), the combined cost may still exceed the $2,100 cap even with MFPs in effect. The cap protects against catastrophic accumulation regardless of MFP availability.1

Catastrophic phase: $0 cost-sharing remains

Effective 2025 under IRA Section 11201, beneficiaries pay $0 cost-sharing in the catastrophic phase. This applies regardless of MFP. Once a beneficiary reaches the $2,100 cap, additional fills cost nothing for the rest of the year.1

Medicare Prescription Payment Plan (M3P) interaction

The Medicare Prescription Payment Plan (M3P) under IRA Section 11202 lets beneficiaries spread their $2,100 out-of-pocket maximum into capped monthly installments across the calendar year instead of paying in full at the pharmacy. M3P operates independently of the MFP and applies to the beneficiary's total Part D out-of-pocket cost, including MFP-discounted fills.1

Constitutional litigation: status as of May 2026

Following the Negotiation Program's enactment in August 2022, multiple major pharmaceutical manufacturers filed federal lawsuits challenging the program on constitutional grounds. The challenges raised four primary arguments.

Fifth Amendment takings: Manufacturers argued that forcing them to sell drugs at a government-determined MFP below market price constitutes a regulatory taking without just compensation. Courts have responded that participation in Medicare is voluntary; manufacturers can withdraw drugs from Medicare to avoid the MFP requirement (though the practical impossibility of doing so was central to the disputes).

First Amendment compelled speech: Manufacturers argued that the requirement to sign an "agreement" and use specific terminology (such as "Maximum Fair Price") compels speech in violation of the First Amendment. Courts have found that ordinary commercial transactions, including required disclosures and contractual agreements, do not implicate compelled-speech doctrine in this context.

Eighth Amendment excessive fines: Manufacturers argued that the IRC Section 5000D excise tax is grossly disproportionate to any government interest and constitutes an excessive fine. Courts have responded that the tax enforces a voluntary regulatory program, not a punitive fine, and is properly enacted under Congress's tax power.

Due process: Manufacturers argued that the price-selection methodology is arbitrary and capricious, violating procedural and substantive due process. Courts have found the methodology rationally related to legitimate government interests in reducing Medicare spending.

Key cases and outcomes (as of May 2026)

• Merck v. Becerra (D.C. Circuit): District court dismissed; D.C. Circuit affirmed. Merck is participating in the negotiation of Januvia.
• Bristol-Myers Squibb v. Becerra (D.N.J.): District court dismissed; Third Circuit affirmed. BMS is participating for Eliquis.
• Boehringer Ingelheim v. HHS (D. Conn.): Dismissed. Boehringer Ingelheim is participating for Jardiance.
• AstraZeneca v. Becerra (D. Del.): Dismissed. AstraZeneca is participating for Farxiga.
• Novartis v. Becerra (D.N.J.): Dismissed. Novartis is participating for Entresto.
• Novo Nordisk v. Becerra (D.N.J.): Dismissed. Novo Nordisk is participating for Fiasp/NovoLog.
• Janssen v. Becerra (D.N.J.): Dismissed. Janssen is participating for Xarelto and Stelara.
• Astellas v. Becerra: Voluntarily withdrew its lawsuit and signed an agreement.

The Supreme Court has not yet granted certiorari on any of the cases. Most manufacturers are now operating under signed agreements while preserving their right to appeal. The program continues to operate, and the 2027 selections were announced on schedule in January 2025.

Future negotiation schedule: 2027 through 2029 and beyond

The Negotiation Program continues to expand each year under IRA Section 11401 and Section 1195 SSA.

2027: 15 additional Part D drugs

Selected drugs include treatments for diabetes and weight loss (Ozempic), pulmonary disease (Trelegy Ellipta), blood cancer (Calquence), neurological conditions (Austedo), and GI conditions (Linzess), among others. CMS announced these selections in January 2025; the MFPs are scheduled for publication in 2026 with a January 1, 2027 effective date.

2028: 15 additional combined Part B and Part D drugs

For the first time, Part B drugs (physician-administered drugs covered under Medicare Part B, such as infusion biologics for cancer and rheumatology) become eligible for negotiation. This significantly expands the program's scope.

2029 and beyond: 20 additional drugs per year

After 2028, the program selects 20 additional drugs annually from the combined Part B and Part D pool. The cumulative effect grows substantially over the decade as more negotiated prices take effect simultaneously, fundamentally changing Medicare drug economics.

Plan formularies and tier placement

Even with MFPs in effect, Georgia beneficiaries must confirm that their plan covers the negotiated drug and at what tier. The $2,100 out-of-pocket cap and MFP discounts apply only to drugs on the plan formulary. A drug not on the plan formulary is not covered unless a coverage exception is granted under Section 1860D-4(g).1

What to check during the Annual Enrollment Period

For Georgia beneficiaries comparing plans during the October 15 to December 7 Annual Enrollment Period:

• Confirm each of your medications is on the plan formulary
• Check the tier placement (Tier 5 specialty vs Tier 3 brand vs Tier 2 generic)
• Confirm the preferred pharmacy network includes your local pharmacy
• Compare premium plus deductible plus expected cost-sharing across plans
• Use the Medicare Plan Finder at medicare.gov, or GeorgiaCares counseling, for help

Tier placement does not change the MFP

MFP-eligible cost-sharing is based on the plan tier. Plans cannot retaliate against negotiated drugs by moving them to higher tiers; CMS rules prohibit anti-MFP formulary discrimination. Plans retain general formulary discretion within their tier structure.

Manufacturers and the future of US drug pricing

The Medicare Drug Price Negotiation Program represents a profound shift in US drug pricing. By creating a price benchmark for high-spend Medicare drugs, it changes manufacturer incentives across the pharmaceutical market. Some likely effects:

Commercial market spillover

While the MFP applies only to Medicare, commercial insurers and PBMs use Medicare benchmarks in their own negotiations. Lower Medicare prices may pressure commercial prices indirectly, though manufacturers may also offset Medicare losses by raising commercial prices.

R&D investment patterns

Manufacturers argue that lower Medicare prices reduce R&D investment in expensive late-stage drugs. Government studies (CBO and others) project modest reductions in new drug development but argue that overall consumer welfare improves.

International reference pricing

The MFP methodology incorporates international reference pricing in some cases, formalizing a long-standing complaint that the US pays disproportionately more than other developed nations.

Patent and exclusivity strategies

Manufacturers may pursue patent extensions and minor reformulations more aggressively to delay generic entry, since drugs become negotiation-eligible only after 9 to 13 years of FDA approval. This dynamic is being studied by CBO and the FTC.

Common mistakes Georgia beneficiaries make about Medicare drug price negotiation

1. Thinking MFPs apply to all drugs. Only 10 drugs are negotiated in 2026, with 15 more in 2027. The vast majority of drugs are not negotiated.

2. Confusing the MFP with the $35 insulin cap. The insulin cap is IRA Section 11406; the MFP is IRA Section 11401. Different provisions, different mechanisms.5

3. Believing MFPs apply to commercial insurance. MFPs apply only to Medicare beneficiaries through participating manufacturers. Commercial market prices are not directly affected.

4. Not realizing MFPs apply at the pharmacy counter. The MFP is operationalized through the Part D plan; beneficiaries see lower cost-sharing automatically.

5. Thinking MFPs only apply in the catastrophic phase. MFPs apply throughout all Part D phases (deductible, initial coverage, and catastrophic).

6. Believing pharmacy networks no longer matter. In-network rules still apply. Out-of-network drug costs do not count toward the $2,100 out-of-pocket cap.1

7. Missing the out-of-pocket cap interaction. Lower MFPs slow accumulation toward the $2,100 cap. Many single-drug beneficiaries on negotiated drugs never reach it.1

8. Confusing manufacturer rebates with MFP discounts. Plans still negotiate rebates above the MFP. The MFP is the floor; plans may secure additional discounts.

9. Thinking MFPs reduce list prices in the commercial market. Manufacturers can charge any price they want commercially; only Medicare gets the MFP.

10. Believing CMS sets prices unilaterally. The process involves manufacturer counter-offers, evidence submissions, and a defined methodology. Manufacturers participate.

11. Not understanding that manufacturers can withdraw drugs from Medicare. They can in theory; in practice, the steep excise tax under IRC Section 5000D makes withdrawal economically prohibitive.

12. Confusing the MFP with Average Sales Price (ASP) or AMP. ASP is the Medicare Part B reimbursement benchmark; AMP is the Medicaid benchmark. The MFP is a new third pricing benchmark for selected Part D drugs.

13. Missing the future negotiation schedule. More drugs are added every year, and the program continues to expand.

14. Not realizing courts have largely upheld the program. Manufacturer constitutional challenges have lost at the district-court and appellate levels. The program continues to operate.

15. Believing pharmacists can give MFP information off the cuff. For specific MFP questions, contact your plan, Medicare, or GeorgiaCares.

Quick reference: 2026 MFPs and Georgia beneficiary impact

Cost-sharing columns are illustrative and assume typical brand (Tier 3) and specialty (Tier 5) coinsurance; your plan's tier, coinsurance, and deductible determine your actual cost, and specialty-drug spending typically reaches the annual out-of-pocket cap early in the year.

Georgia Medicare Drug Price Negotiation Resources

Free help understanding the Medicare Drug Price Negotiation Program, Maximum Fair Prices for the first 10 selected drugs, the out-of-pocket cap interaction, and your Part D options is available from these Georgia and federal organizations.

Learn More

Find personalized help comparing Part D plans and understanding Maximum Fair Prices at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.