Medicare's open enrollment period began yesterday and runs through December 7. For the next seven weeks, people on Medicare can choose between traditional Medicare and private Medicare Advantage plans and pick their drug coverage, and the choices take effect on January 1. This year, January 1 also brings Medicare's newly negotiated prices for fifteen drugs. Three of them are semaglutide, sold as Ozempic, Wegovy, and Rybelsus.
This is the third time I've written about these drugs. In January it was the cash-price deals; in July, Medicare's new $50 copay for obesity treatment. This one is about something harder to see: the same medicine now has at least three prices in Medicare.
The first price is the negotiated one. Under the 2022 Inflation Reduction Act, Medicare bargained directly with drugmakers, and last November it announced that semaglutide's monthly price would be $274, down from a 2024 list price of $959. The stakes are large: 2.3 million Medicare enrollees used semaglutide in 2024, at a gross cost of $15.2 billion. Across all fifteen drugs, Medicare estimated that if the new prices had applied in 2024, its spending on them would have been 44% lower, about $12 billion.
But a negotiated price is what the plan pays, not what the patient pays. Medicare estimated that enrollees' own out-of-pocket costs on the fifteen drugs would have fallen by $685 million, a real number, but a small slice of the $12 billion. As KFF explains, whether a patient's bill drops depends on how their plan charges. Patients who pay coinsurance, a percentage of the price, could see savings. For patients on a flat copay, the discount doesn't automatically reach the counter. Plans must cover the negotiated drugs, but they still set the cost-sharing; CMS has said it will review plans that put negotiated drugs on worse tiers or under stricter rules than their competitors, and expects a clinical reason when they do.
The second price is the $50 one. Since July, Medicare's GLP-1 Bridge has let some enrollees get Wegovy and certain other weight-loss drugs for a flat $50 a month. To qualify, a patient needs a body-mass index of 35 or higher, or 27 or higher with a condition like heart disease or prediabetes, plus prior authorization. The Bridge sits outside regular Part D coverage. Its $50 payments don't count toward the Part D deductible or the annual out-of-pocket cap, and people who get Extra Help, Medicare's subsidy for low-income enrollees, can't use it for these drugs. The Bridge was supposed to lead into a longer-term program, but too few Part D plans signed up for 2027, so Medicare extended the Bridge through the end of next year instead. After that, nothing is guaranteed.
The third price is the list price, which still matters to anyone who pays a deductible or a percentage. Novo Nordisk, which makes all three semaglutide drugs, announced in February that it would cut list prices 35% to 50% starting in 2027.
Meanwhile, the rest of Part D shifts too. The annual out-of-pocket cap rises from $2,100 to $2,400, the standard deductible climbs from $615 to $700, and a temporary federal subsidy that held down Part D premiums ends this year.
None of this undoes the achievement. The negotiated savings are real, and large. My desk's point is only the one it always makes: a price exists for whoever can reach it. In 2027, reaching it means picking the right plan during these seven weeks, or knowing the Bridge exists, or having a prescriber who will file the prior authorization.
In July I ended at the pharmacy counter, with a woman asking the price twice. This fall the question moves to a kitchen table and a plan comparison website, and the answer depends on which plan she picks before December 7.
