IRA Drug Negotiation: Improved Medicare Part D Coverage in 2026 & 2027
A key component of the Inflation Reduction Act of 2022, the Medicare Drug Price Negotiation programme, is already demonstrating an impact on access to prescription medications for Medicare beneficiaries. The programme allows the federal government to negotiate prices for some high-cost drugs covered by Medicare, and crucially, requires all Medicare Part D plans to cover those selected drugs in all available dosages and forms once negotiated prices take effect.
Improved Coverage in 2026
The IRA’s Impact on Drug Access
Analysis of 2026 Medicare Part D formulary coverage reveals that the IRA’s coverage requirement is working as intended. For nine of the first ten drugs selected for price negotiation, coverage rates have improved since 2025, before the requirement was in place. In 2026, all Part D enrollees have coverage for all ten selected drugs, including all dosage forms, and strengths.
Specific Drug Coverage Gains
The insulin products Fiasp and NovoLog saw significant gains in coverage. Fiasp, covered for only 24% of Part D enrollees in 2025, now has broader access. Similarly, NovoLog coverage expanded from 32% in 2025. Two dosages of the cancer drug Imbruvica, previously covered for roughly half of enrollees, are now more widely available.
Looking Ahead to 2027
Expanding Access with Wegovy and Other Drugs
The impact of the IRA is expected to continue with the inclusion of 15 additional drugs in 2027. The GLP-1 drug Wegovy, approved for both obesity and cardiovascular disease risk reduction, is currently covered by fewer than 1% of Part D plans. However, Medicare currently only covers Wegovy for cardiovascular disease, as it is prohibited from covering drugs used for weight loss.
A Potential Shift in Coverage
The Trump administration is considering a temporary, voluntary model to expand Medicare coverage of GLP-1s to treat obesity, potentially allowing broader access to Wegovy for this purpose beginning in 2027. The IRA’s coverage requirement will also increase coverage for six other selected drugs for 2027 – Austedo and Austedo XR, Otezla, Breo Ellipta, Xtandi, Pomalyst, Ofev, Ibrance, Calquence, and Vraylar – which are not currently universally covered.
Frequently Asked Questions
What is the Medicare Drug Price Negotiation programme?
The Medicare Drug Price Negotiation programme, enacted as part of the Inflation Reduction Act of 2022, allows the federal government to negotiate the price of some high-cost drugs covered by Medicare.
What is the impact of the IRA’s coverage requirement?
The IRA requires all Medicare Part D plans to cover drugs selected for negotiation, leading to improved coverage rates for these medications, including all dosages and forms.
Which drugs are included in the first two rounds of negotiation?
The first 10 drugs selected for negotiation have Medicare-negotiated prices available as of January 1, 2026. An additional 15 drugs have been selected for price negotiation, with negotiated prices taking effect in 2027.
As the Medicare Drug Price Negotiation programme continues to unfold, how might these changes affect your healthcare decisions and access to prescription medications?