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Drugmakers will likely be able to handle the impacts of the third round of Medicare negotiations, analysts say, even as the biopharma industry continues to criticize the Biden-era program. On Tuesday, CMS unveiled the next 15 drugs up for negotiation, which include AbbVie’s Botox, Eli Lilly’s diabetes drug Trulicity, and Gilead’s HIV treatment Biktarvy. Analysts said some of the drugs were widely anticipated to make the list. They cited past negotiations, upcoming patent losses and new drug development as some reasons why the potential impacts may be modest. “With prior rounds of pricing negotiations reasonable, and several of these medicines set to lose exclusivity in the near-term, we continue to expect that the impacts will be manageable,” BMO Capital Markets analyst Evan Seigerman said in a note to investors. He called out Biktarvy, Botox, Trulicity, Eisai’s Lenvima, Bristol Myers Squibb’s Orencia, Lilly’s Verzenio and Pfizer’s Xeljanz specifically, as they fall under BMO’s coverage. CMS said the 15 new drugs on the list cost Medicare Part B and Part D about $27 billion from November 2024 through October 2025. But Leerink analysts suggested in a note that Biktarvy is “the only one of the 15 drugs that has [estimated] Medicare exposure that is material.” Even so, Leerink analyst Daina Graybosch told Endpoints News in an interview that the impact on Gilead’s revenue is likely “modest.” “Investors are thinking more about the growth beyond Biktarvy anyways,” she said, citing the company’s “really rich HIV pipeline.” Gilead launched its twice-yearly drug for HIV prevention Yeztugo last year, and said earlier this month that it hopes to have up to seven HIV prevention and treatment launches by the end of 2033. A Gilead spokesperson said on Wednesday that the company plans to participate in negotiations, and is “committed to demonstrating the value and innovation of our medicines while supporting patient access and affordability.” Some drugmakers continue to attack the program. Novartis called the program unconstitutional in a statement to Endpoints on Tuesday, and Bristol Myers said “the IRA’s forced sale regime is deeply flawed.” The BMS spokesperson added that the program “creates negative, long-term implications on patient access, R&D and future innovation.” Novartis and BMS are two of six drugmakers that have asked the Supreme Court to review challenges they brought against the first round of Medicare negotiations. PhRMA EVP of policy and research Elizabeth Carpenter said the law is “the wrong approach for Americans,” and is “undermining future medical progress.” Some drugmakers suggested in early statements they would cooperate with CMS. UCB said it is “prepared to work collaboratively” with the agency in discussions for its drug Cimzia. Takeda said it anticipated the inclusion of its drug Entyvio for Crohn’s disease and ulcerative colitis, and has been “actively preparing” for possible negotiations. A spokesperson said the company is “focused on supporting continued access to Entyvio for patients who may benefit from this critical medicine.” Otsuka, which markets the  antipsychotic medicine Rexulti with Lundbeck, told Endpoints that it “remains committed to ensuring patients have access to safe and effective treatments for serious mental illnesses and neurological conditions.” Lundbeck noted that Rexulti’s patent expiration is in mid-2029, and that “approximately 35% of US Rexulti revenue is exposed to Medicare.”

Several of Big Pharma's high-profile blockbusters feature on the list of first-time Medicare price negotiations for 2026. Even as the Trump administration works to implement its most-favored-nation pricing system, the U.S. government continues to advance efforts to negotiate Medicare drug prices as enabled by the Inflation Reduction Act (IRA). Tuesday, the Centers for Medicare & Medicaid Services (CMS) unveiled the next 15 high-spend medicines up for price negotiations under the program. Meds up for first-time Medicare price negotiations this year include GSK's inhaler Anoro Ellipta, Gilead Sciences' HIV blockbuster Biktarvy, AbbVie's Botox and Botox Cosmetic brands, Takeda's inflammatory bowel disease drug Entyvio and Johnson & Johnson prostate cancer medicine Erleada, according to a Jan. 27 release from the CMS.In addition, Novartis' breast cancer medicine Kisqali, Eisai's cancer therapy Lenvima, Lundbeck and Otsuka's atypical antipsychotic Rexulti, Eli Lilly's diabetes drug Trulicity and its breast cancer treatment Verzenio are also due for first-time negotiations, according to the government.Rounding out the list are Roche and Novartis' Xolair for food allergies, chronic hives and other uses, plus immunology biologics Cosentyx, Cimzia, Orencia and Xeljanz from Novartis, UCB, Bristol Myers Squibb and Pfizer, respectively.In a note to clients, Leerink Partners analysts said the IRA price negotiations will be mostly immaterial for the selected companies and drugs. Biktarvy is the exception, as the drug’s Medicare sales are projected to make up 8% of Gilead’s overall revenue base in 2027, the analysts said.For the other drugs on the list, Medicare revenues account for 0% to 3% of projected company totals in 2027, according to the analysts. Also for the first time, the government will renegotiate a drug's price under the IRA system, tagging Boehringer Ingelheim's diabetes med Tradjenta for renegotiations. The drug was previously included in last year's batch of pricing talks.After the negotiation process for the drugs kicks off this year, their new Medicare prices will become effective in early 2028, according to the CMS. Drugmakers have until the end of February to decide whether to participate in the process.About 1.8 million people used one or more of the 15 drugs through Medicare Part D or Part B between November 2024 and October 2025, the CMS said. The batch of 15 meds accounted for about $27 billion in prescription drug spending in Medicare over that time frame, or about 6% of total Part B and Part D spending, the CMS said.The list also includes the first Medicare Part B medicines to face IRA-enabled cost cuts. Drugs in this group are typically given by doctors rather than obtained at pharmacies. The move comes shortly after the first batch of IRA-enabled Medicare price cuts went into effect at the start of the year. The pharmaceutical industry has wagered a public campaign against the IRA price negotiations, likening the system to government price controls rather than genuine negotiations given the harsh penalties for noncompliance, but, so far, the industry hasn't been able to meaningfully resist the IRA measures. Several IRA lawsuits are making their way to the Supreme Court, Endpoints News reported this week.The Trump administration continues to implement IRA measures even as President Donald Trump's preferred drug pricing mechanism in his second term centers on aligning international and domestic drug costs. His most-favored-nation push has resulted in pricing concessions from 16 drugmakers, though many of the details of those deals have not been released. In general, the deals are designed to provide direct patient access to certain drugs at discounted prices.Editor's note: This story was updated to include analysis from Leerink Partners.