Medicare beneficiaries are paying more for price-negotiated drugs, survey finds

Almost half of Medicare Part D beneficiaries believe they are paying more this year for prescription drugs, including any of the first 10 selected drugs for price negotiations, according to a new survey by the law firm DLA Piper. Thirty percent of respondents also experienced access issues, including prior authorization requirements and drug availability concerns.

The Maximum Fair Price (MFP), established by the Inflation Reduction Act, allows CMS to negotiate prices for Medicare Part D drugs. In 2023, about 8.8 million people with Medicare were prescribed the first 10 negotiated drugs that had their prices negotiated. The new prices for the first 10 took effect in January 2026:

• Eliquis (apixaban): Blood clot prevention and treatment
• Enbrel (etanercept): rheumatoid arthritis, psoriasis, psoriatic arthritis
• Entresto (sacubitril/valsartan): Heart failure
• Farxiga (dapagliflozin): Diabetes, heart failure, chronic kidney disease
• Imbruvica (ibrutinib): Blood cancers
• Januvia (sitagliptin): Diabetes
• Jardiance (empagliflozin): Diabetes, heart failure, chronic kidney disease
• NovoLog/Fiasp (insulin aspart): Diabetes
• Stelara (ustekinumab): Psoriasis, psoriatic arthritis, Crohn’s, ulcerative colitis
• Xarelto (rivaroxaban): Blood clot prevention, reducing risk of coronary artery disease

When the prices were announced in August 2024, the negotiated discounts for these 10 drugs ranged from 38% to 79% off list prices, CMS said. Officials estimated had the negotiated prices been in effect, they would have saved an estimated $6 billion in net covered prescription drug costs, or approximately 22%, across the 10 selected drugs.

The law firm wanted to look at whether patients taking these drugs perceived any decrease in costs, access, plan changes and cost protections. The survey was conducted online with 153 beneficiaries in June 2026 and July 2026.

Among the key findings:

• 46% of respondents reported paying more for at least one of the 10 drugs after the negotiated pricing went into effect.
• About 40% were not aware of the $2,100 cap on out-of-pocket drug costs or the Medicare Prescription Payment Plan.
• 30% experienced barriers to accessing medications this year compared with 25% in 2025. The common challenges faced include prior authorization and drug availability.
• 62% of respondents expressed concern about future access to medications because of plan changes.
• Those with the stand-alone prescription drug plan were more likely to report premium increases; those with Medicare Advantage plans were more likely to report paying more for their drugs.

Eighty-seven percent of respondents remained in the same Medicare drug plan they had in 2025, while 13% switched to a different plan. Among those who switched, reasons included finding a plan with a lower premium (45%) and the previous plan being discontinued (25%). Overall, 39% of respondents reported their monthly premiums had increased in 2026, while 45% stated that premiums had stayed the same, and 9% experienced a decrease.

Additionally, 29% of those surveyed reported that their plan had changed coverage or was charging more out-of-pocket for one or more of the 10 selected drugs compared with 2025, while 67% reported no change in how their plan covered these drugs. Overall, 62% reported being concerned that changes to their drug plan could affect their ability to continue taking their medicines in the future; 19% were being extremely concerned and 43% somewhat concerned.

Related: Payers lean on step therapy, formulary exclusions as IRA reshapes Part D benefit design

These findings align with a recent survey by Spherix Global Insights. Health plans and pharmacy benefit managers are restructuring their benefit designs, and not just for Medicare plans.

Payers surveyed by Spherix say they are increasing step therapy (68%), raising premiums (65%), accelerating generic and biosimilar preferencing (59%), and expanding total formulary exclusions (54%). The therapeutic categories experiencing the most disruption in preferred placement include diabetes (57%), dermatology (32%), and rheumatology (32%).

DLA Piper said its survey highlights several areas for further review, including increasing outreach to increase awareness of out-of-pocket caps and the Medicare Prescription Payment Plan. Additionally, beneficiary concern about future access could provide context for plan benefit design, market stability, patient costs, and access to needed medicines.