Medicare Cut Ozempic to $274 for 2027. Your Plan Still Decides What You Pay at the Counter.

Fifteen brand-name drugs get negotiated prices on Jan. 1. Here’s where the discount actually shows up on your bill, where it doesn’t, and the three lines in this month’s plan letter that tell you which one you’re getting.

On Jan. 1, 2027, the negotiated Medicare price for a month of Ozempic drops from a $959 list price to $274 (CMS fact sheet, Nov. 25, 2025). About 2.3 million people on Part D used it or its sister drugs in 2024. If you’re one of them, the natural next question is whether your pharmacy bill falls 71% too. Sometimes yes. Often not. Here’s the honest version.

What happened

The Inflation Reduction Act of 2022 let Medicare negotiate prices on a handful of high-spend drugs each year. The first 10, including Eliquis, Jardiance and Januvia, took effect this January. The second batch of 15 kicks in Jan. 1, 2027, and it’s the one most likely to touch your medicine cabinet (Medicare Rights Center, Oct. 9, 2025).

The biggest names and their new 30-day prices, next to the 2024 list prices CMS used for comparison (CMS fact sheet via Healthcare Dive, Nov. 26, 2025):

• Ozempic, Rybelsus, Wegovy (semaglutide): $274, down from $959. 2.3 million users.
• Trelegy Ellipta (COPD/asthma): $175, down from $654. 1.3 million users.
• Breo Ellipta (asthma/COPD): $67, down from $397. 626,000 users.
• Linzess (IBS/constipation): $136, down from $539. 632,000 users.
• Tradjenta and Janumet (diabetes): $78 and $80, down from $488 and $526.
• Xifaxan (IBS): $1,000, down from $2,696.

The rest treat cancer, lung scarring, psoriasis, movement disorders and mental health conditions: Xtandi, Pomalyst, Ofev, Ibrance, Calquence, Austedo, Vraylar and Otezla. Together, the 15 accounted for $42.5 billion in Part D spending in 2024, and CMS estimates enrollees would have saved about $685 million out of pocket that year at the new prices (AARP, updated Jan. 13, 2026).

What this means for your wallet

Medicare negotiated the drug’s price, not your copay. Every plan must cover all 15 drugs in 2027 (AARP, Jan. 13, 2026), but each plan still decides the tier, the copay or coinsurance, and whether it wants prior authorization first (24/7 Wall St., Aug. 21, 2026). Whether the discount reaches you depends on which of three ways your plan charges for the drug.

1. You’re in the deductible. Until you meet your plan’s deductible, you pay the drug’s full negotiated price yourself (NCOA, 2026). The 2027 maximum deductible is $700 (CMS, final 2027 Part D redesign instructions, April 2026). So a January Trelegy fill runs about $175 instead of about $654. That’s the cleanest win in the whole program.

2. Your plan charges a percentage. If Ozempic sits on a tier with 25% coinsurance, 25% of $274 is about $69 a month, versus about $240 at the old list price. Same plan, same tier, roughly $170 less. Coinsurance tiers are where the headline discount comes closest to reaching you.

3. Your plan charges a flat copay. A $47 copay in 2026 can still be a $47 copay in 2027. Or $55. Plans set flat copays independently of the drug’s price. Readers on the Medicare Rights Center site reported exactly this after the first round: one wrote that his plan raised his Eliquis cost 20% for 2026 even though the negotiated price fell (Medicare Rights Center comments, Nov. 28, 2025).

One backstop covers all three cases: in 2027, once your out-of-pocket drug spending hits $2,400, covered drugs cost $0 for the rest of the year (CMS, April 2026).

The three lines to check this month

Your plan’s Annual Notice of Change has to reach you by Sept. 30 (Medicare.gov). For each drug you take, find these three things:

• Tier. Did your drug move up a tier for 2027? A tier change can wipe out the price cut.
• Copay or coinsurance. A percentage passes the discount along. A flat dollar amount may not.
• Restrictions. Look for “PA” (prior authorization) or “ST” (step therapy) next to the drug name. Plans can still require both on negotiated drugs.

Then run your exact drugs, doses and pharmacy through Medicare Plan Finder between Oct. 15 and Dec. 7. It shows what each plan actually charges, not the negotiated price. The Medicare Rights Center’s own answer to “what will my copay be?” is that there is no single number; it depends on the plan (Medicare Rights Center, Jan. 6, 2026). Free, unbiased help is available from your State Health Insurance Assistance Program at shiphelp.org or 877-839-2675.

The takeaway

The $274 price is real, and for people in the deductible or on a coinsurance tier, it’s real money. For people on flat copays, January may look exactly like December. The number that matters is on your plan’s letter, not in the news. Read it before it auto-renews you.

This is information, not medical, financial or insurance advice. Drug coverage depends on your plan, dose and pharmacy; talk to your plan, your pharmacist or a SHIP counselor about your situation. Senior Savers is independent and not affiliated with Medicare or any insurer, and has no financial relationship with any company or organization named here.

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