Medicare 2026

Ozempic, Wegovy and Rybelsus Get a Medicare Negotiated Price in 2027: What It Means

Starting January 1, 2027, three widely used semaglutide medicines — Ozempic, Rybelsus and Wegovy — will carry a Medicare "negotiated price" (the law calls it the maximum fair price). The headline number: $274 for a 30-day supply, compared with a 2024 list price of $959 — about 71 percent lower. These three drugs were the biggest Part D spending drivers among the 15 medicines in this negotiation round, with roughly 2,282,000 Part D enrollees using them in 2024.

Here is what the change actually does, what it does not do, and how to think about it as you look at your Medicare drug coverage.

What the negotiated price is — and is not

Under Medicare's drug price negotiation program, the maximum fair price is the price the drug company must make the medicine available at to people with Medicare and to the pharmacies that dispense it. CMS has posted the price by package:

• $276.78 for a 4 mg/3 mL Ozempic pen
• $276.78 for 30 Rybelsus 7 mg tablets
• $385.63 for four Wegovy 2.4 mg pens

That is the ceiling the manufacturer charges into the system. It is not automatically your copay. What you pay at the pharmacy still depends on your plan's deductible, which tier the drug sits on, and the plan's cost sharing for that tier.

The good news is that Medicare's annual Part D out-of-pocket cap continues to work as a safety net. In 2027, once your out-of-pocket spending on covered Part D drugs reaches $2,400, you pay $0 for covered drugs the rest of the year. (For reference, the cap is $2,100 in 2026.)

Which uses are covered under Part D

Part D can cover GLP-1 medicines for medically accepted uses other than weight loss. Specifically:

• Ozempic, Rybelsus, Mounjaro and Trulicity are approved to treat type 2 diabetes.
• Wegovy is also approved to lower the risk of heart attack and stroke in adults with established heart disease who have obesity or overweight.
• Zepbound is also approved for moderate-to-severe obstructive sleep apnea in adults with obesity.

For any of these uses, the plan's formulary and utilization rules apply. Prior authorization is common for GLP-1 drugs, so expect your prescriber to document the diagnosis and medical history.

Wegovy prescribed strictly for weight loss is a different situation. Part D by law does not cover drugs used for weight loss. For people who qualify, Wegovy for weight loss is covered under the temporary Medicare GLP-1 Bridge program at $50 a month, running July 1, 2026 through December 31, 2027.

What has to be on your plan's formulary

By law, every stand-alone Part D plan and every Medicare Advantage plan that includes drug coverage must list the negotiated-price drugs on its formulary beginning in 2027. That means Ozempic, Rybelsus and Wegovy will be on the formulary of your drug plan — but the tier, cost sharing, step therapy requirements and prior authorization rules are set by each plan. Two plans can both "cover" the same drug and still result in very different out-of-pocket costs.

Numbers to know for 2027

• Part D out-of-pocket cap: $2,400
• Maximum Part D deductible a plan may charge: $700
• Part D base beneficiary premium: $41.33 (a national figure used to calculate the late-enrollment penalty; actual plan premiums are set plan by plan)
• Social Security COLA: 3.6 percent, announced October 14, 2026, for benefits payable beginning January 2027

A few 2027 figures are not yet public. CMS typically announces the Part B standard premium and deductible, along with the IRMAA income brackets and surcharges, in the fall — usually November. Check Medicare.gov once those are released.

When to make changes

Medicare's Annual Enrollment Period runs October 15 – December 7, 2026, with choices taking effect January 1, 2027. That is the main window to:

• Switch Part D plans or Medicare Advantage plans
• Move between Original Medicare (with a stand-alone Part D plan) and Medicare Advantage
• Join a Part D plan for the first time if you are eligible

If you have Medicaid or get Extra Help with Part D costs, you have additional flexibility. Since 2025, there is a monthly Special Enrollment Period that lets you move to Original Medicare with a stand-alone Part D plan, or switch stand-alone Part D plans. Full-benefit dual-eligible individuals can also enroll in an integrated D-SNP in any month.

Original Medicare + Medigap vs. Medicare Advantage: a neutral note

Because the negotiated price applies on the Part D side, people often ask whether they should rethink their overall coverage structure. Both paths have trade-offs:

• Original Medicare with a Medigap policy and a stand-alone Part D plan generally gives broad provider access nationwide and predictable supplemental cost sharing, with a separate drug plan premium and separate Medigap premium.
• Medicare Advantage usually bundles medical and drug coverage, often uses provider networks and prior authorization, and plan designs vary considerably.

Neither is universally better. The right fit depends on your doctors, your medicines, how you use care, and your budget.

What does this mean for people with Medicare?

The 2027 negotiated price is a meaningful change for a group of medicines many people with Medicare rely on. It lowers what the system pays for the drug, requires every drug plan to list it, and works alongside the $2,400 Part D out-of-pocket cap. It does not override plan rules like prior authorization or guarantee a specific copay.

For the most current, plan-specific details — including the 2027 Part B figures when CMS announces them — go to Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048), available 24 hours a day, 7 days a week.