Prescription drug costs for 2027: what's changing for Medicare and job-based plans

Drug costs are one of the biggest worries during open enrollment. Here is a plain-language roundup of the latest official news on what people pay for prescriptions, both on Medicare and in job-based (employer) plans. Everything here is as of November 1, 2026, and each item lists its source below.

Medicare: the yearly drug cap goes up in 2027

Medicare drug plans (Part D) have a yearly cap on what you pay for covered drugs. According to Medicare.gov:

• The cap is $2,100 in 2026 and $2,400 in 2027. Once you reach it, you pay nothing more for covered Part D drugs for the rest of that year.
• No Medicare drug plan may have a deductible over $615 in 2026 or $700 in 2027.
• Covered insulin costs no more than $35 for a one-month supply of each product, with no deductible.

If big bills in one month are hard, the Medicare Prescription Payment Plan lets you spread your drug costs over the year. Medicare.gov notes it doesn't lower the total you pay.

Medicare: 15 more negotiated drug prices start January 1, 2027

Under the Medicare Drug Price Negotiation Program, Medicare negotiates prices for some high-cost brand-name drugs. Negotiated prices for the first 10 drugs took effect January 1, 2026.

On November 25, 2025, CMS announced negotiated prices for 15 more drugs, starting January 1, 2027. They include Ozempic, Rybelsus, and Wegovy (one listing), Trelegy Ellipta, Xtandi, Pomalyst, Ofev, Ibrance, Linzess, Calquence, Austedo, Breo Ellipta, Xifaxan, Vraylar, Tradjenta, Janumet, and Otezla.

A few facts from CMS's fact sheet:

• The negotiated 30-day price for Ozempic, Rybelsus, and Wegovy is $274, compared with a 2024 list price of $959.
• About 5.3 million people with Medicare drug coverage used these drugs in 2024.
• CMS estimates people with Medicare drug coverage would save about $685 million in out-of-pocket costs in 2027 (under the standard benefit design).

Keep in mind: the negotiated price is what Medicare drug plans pay for the drug. It isn't your copay. What you pay still depends on your plan, your deductible, and the yearly cap.

What's next: In January 2026, CMS picked 15 drugs for the third round, including the first drugs covered under Part B (drugs usually given in a doctor's office). CMS says it will publish those negotiated prices by November 30, 2026, and they would take effect January 1, 2028. As of November 1, 2026, those prices have not been published yet.

GLP-1 drugs: a new Medicare option, and mixed employer coverage

GLP-1 drugs (like Wegovy and Zepbound) are expensive, and coverage for weight loss has been limited.

On Medicare: CMS launched the Medicare GLP-1 Bridge on July 1, 2026. It runs through December 31, 2027. Eligible people pay a $50 copay per month for certain covered GLP-1 drugs used for weight management. A few key points from CMS and Medicare.gov:

• You need to meet medical and weight (BMI) requirements, and prior authorization is required.
• People who already get a GLP-1 through their Part D plan, or who have certain conditions such as type 2 diabetes, aren't eligible for the Bridge. Their drug plan may already cover GLP-1s for those conditions.
• The $50 copays don't count toward your Part D deductible or the yearly out-of-pocket cap.
• Medicare.gov's eligibility tool walks you through the rules: https://www.medicare.gov/coverage/weight-loss-drugs

At work: KFF's 2026 Employer Health Benefits Survey (released October 22, 2026) found that 18% of large firms (200 or more workers) cover GLP-1s for weight loss, about the same as 19% last year. Coverage is more common at the biggest employers: 33% of firms with 5,000 or more workers cover them. Among large firms that cover them, 40% require people to take part in a lifestyle program or meet similar conditions.

If you take a GLP-1 or are thinking about it, check your plan's drug list during open enrollment. Look for prior authorization rules too. See Prescription drug costs: how your plan works.

Generics and biosimilars: more lower-cost options

Generic drugs and biosimilars (lower-cost versions of biologic drugs) are some of the best ways to pay less.

• On March 9, 2026, the FDA announced new draft guidance meant to make biosimilars faster and cheaper to develop. The FDA says biologics are just 5% of prescriptions but 51% of drug spending. As of that date, the FDA had approved 82 biosimilars.
• Competition is also changing the Medicare negotiation list. CMS removed Stelara, Entresto, and Xarelto from the negotiated-price list effective January 1, 2027, because generic or biosimilar versions came to market.

If your doctor prescribes a brand-name drug, it's always fair to ask, "Is there a generic or biosimilar that would work for me?"

Job-based plans: costs keep rising, and new rules for "middlemen"

Costs: KFF's 2026 survey found the average yearly premium for family coverage is $28,303, and workers pay $7,471 of that on average.

Ways employers are trying to save on drugs (KFF 2026, firms with 50 or more workers):

• 33% offer access to lower-cost generic drugs by mail through outside vendors, such as GoodRx, SingleCare, or Mark Cuban Cost Plus Drug Company.
• 11% limit coverage of certain prescriptions to mail-order pharmacies only.

New rules for pharmacy benefit managers (PBMs): PBMs are the companies that run drug benefits for many employer plans. They build drug lists and negotiate rebates.

• A federal law signed on February 3, 2026 (the Consolidated Appropriations Act, 2026) will require PBMs to pass 100% of drug-maker rebates and fees through to employer health plans. This starts with plan years beginning on or after August 3, 2028.
• The U.S. Department of Labor has issued a final rule requiring PBMs to disclose their fees and other pay in detail to large self-insured employer plans (generally those with 100 or more employees or participants). It takes effect January 4, 2027, and applies to plan years beginning on or after July 1, 2027.

These rules mostly help employers see where drug money goes. They don't directly set your copay. Any savings would show up only if your employer changes its plan.

What you can do now

1. Check your drugs against the plan's drug list before open enrollment ends.
2. Turning 65 or have Medicare? Medicare's Open Enrollment runs October 15 to December 7 each year, and you can compare drug plans on Medicare.gov. Still working? Read Turning 65 and still working.
3. Ask about lower-cost options: generics, biosimilars, mail order, and 90-day supplies.
4. Compare prices carefully. Medicare.gov notes that if you use a discount card (such as TrumpRx.gov prices) instead of your Medicare plan, that purchase doesn't count toward your Medicare deductible or out-of-pocket maximum.

We'll add an update when CMS publishes the third round of negotiated prices.