Vlada
2026-10-15 · on LinkedIn ↗
Medicare negotiated 15 drugs for 2027. Nine need approval first.
The 2027 Medicare drug lists are out. We loaded every plan's list into Vlada. 9 of the 15 newly negotiated drugs need approval first.
Medicare negotiated the price of 15 more drugs. The new prices start in January 2027. These drugs cost Medicare $42.4 billion in 2024.
Every plan now lists all 15. That part is new for some. Austedo was on the lists of 76% of members in 2026, and Otezla 66%. For 2027, both are on every list.
But for 9 of the 15, nearly every plan asks your doctor for approval before you can fill it. Ozempic and Wegovy. Xtandi, Ibrance, Pomalyst and Calquence for cancer. Ofev, Austedo, Otezla and Xifaxan. Together that is $30.4 billion of the $42.4 billion.
For 7 of those 9, nothing changed. They needed approval in 2026, and they still do. The new price did not remove the step. Austedo and Otezla arrive on every list with it.
The other 6 are easier. Almost no plan asks first for Trelegy, Breo, Linzess or Tradjenta.
An approval step is not a denial. But covered is not the same as easy to get. If you or a parent take one of these, read your 2027 list before December 7.
Medicare set the price. Your plan still sets the rules.
- Source
- CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information (2026-09 edition; 2026-10 edition 2027_20261008.zip, the first plan year 2027 formulary); CMS monthly enrollment by plan, September 2026; CMS 2027 plan crosswalk; CMS Medicare Part D Spending by Drug 2024; NLM RxNorm (RxNav) for drug names. Vlada analysis.
- Measure
- For each of the 15 drugs (CMS's 2027 negotiated drugs, identified by the formulary file's own SELECTED_DRUG_YN flag in the 2027 edition and grouped by active ingredient as CMS lists them, counting every brand and generic-name listing of that ingredient), the member-weighted share of members whose plan's CMS formulary lists the drug with prior authorization required. Members whose plan does not list the drug count as not needing approval. 2026 = the September 2026 formulary edition weighted by September 2026 plan enrollment; 2027 = the October 2026 edition (first plan-year 2027 formulary) with the same members carried to their 2027 plan by the CMS 2027 crosswalk; the 2027 base is the members whose plans continue (44.6 million of 48.3 million). Spending = CMS Part D gross spending 2024 summed over the drug's brand names.