CMS announces a $274 Medicare negotiated price for semaglutide starting in 2027

The Centers for Medicare & Medicaid Services announced on November 25, 2025 that it had reached a negotiated price of $274 for a 30-day supply of semaglutide — sold as Ozempic, Rybelsus and Wegovy — under the second round of the Medicare Drug Price Negotiation Program ^[1][2]. The price, which the law calls a "maximum fair price," is 71% below the $959 list price CMS recorded for a 30-day supply in 2024 and takes effect January 1, 2027 ^[1].

Semaglutide was the biggest single line item in the group. Novo Nordisk's three semaglutide products accounted for about $15.16 billion in total Part D gross covered prescription drug costs in 2024, and roughly 2,282,000 Medicare Part D enrollees used them that year ^[1][4]. Across all 15 drugs negotiated in this round, 5.3 million of the 53 million people with Part D coverage filled prescriptions, totaling $42.5 billion, or about 15% of total Part D gross covered drug costs in 2024 ^[1].

The $274 figure is an average, not a single price

The $274 headline number reflects a weighted 30-day supply. The actual maximum price varies by dosage form and strength ^[4]. CMS published examples: a 4mg/3mL Ozempic pen and a 30-count package of 7mg Rybelsus tablets each carry a maximum fair price of $276.78, while a package of four 2.4mg/0.75mL Wegovy pens is capped at $385.63 ^[1][4].

The discounts across the 15 drugs ranged from 38% for Austedo, used for movement disorders, to 85% for the diabetes combination Janumet ^[1][5]. Two other diabetes drugs made the list: Tradjenta at $78 (84% off) and Janumet at $80 ^[1]. CMS estimated that if these prices had been in effect in 2024, Medicare would have saved about $12 billion, or roughly 44% of net spending on the group; including Coverage Gap Discount Program spending, the estimate drops to about $8.5 billion, or 36% ^[1]. Beneficiary out-of-pocket spending would have been $685 million lower ^[2].

A second, lower price is also on the table

The negotiated price sits alongside a separate deal the Trump administration announced with Novo Nordisk on November 6, 2025, under which the company committed to offering Medicare a "most favored nation" price of $245 for all forms of semaglutide starting in 2026 — a year before the negotiated price takes effect, and $29 below it ^[4][5]. CMS officials said the two tracks were negotiated separately ^[4].

Why the same company agreed to two different Medicare prices is not explained in the available documents. "It's not clear why Novo would promise a different price in two different venues," Benjamin Rome, a health policy researcher at Brigham and Women's Hospital, told NPR ^[5]. Novo Nordisk said it "look[s] forward to additional clarity from CMS on how pricing and coverage will work," while restating that it "remain[s] opposed to government price setting" ^[5].

Why it matters for patients

These are prices Medicare and its Part D plans pay, not a guaranteed copay. Still, when a maximum fair price is lower, cost-sharing that is calculated as a percentage of the drug's price falls with it, which reduces pressure at the pharmacy counter ^[3]. Health Affairs analysts note that the effect on individual patients may be smaller than the headline discount suggests, because the Inflation Reduction Act's $2,000 annual out-of-pocket cap took effect in January 2025 and already limits what beneficiaries with high drug bills pay in a year ^[3].

Coverage is a separate question from price. The November 6 agreement was described as expanding access in Medicare and Medicaid for people with a body mass index above 35, and for people with a BMI above 27 who have additional health conditions, but the details of how that will work remain unclear ^[5]. Nothing in these documents changes coverage for people with commercial insurance or those paying cash.

What happens next

January 1, 2026: negotiated prices for the first 10 Part D drugs take effect ^[4]. By February 1, 2026: CMS names 15 more Part B or Part D drugs for 2028 ^[4]. By November 30, 2026: CMS publishes those 2028 prices ^[4]. January 1, 2027: the semaglutide price and the other 14 take effect ^[1][4].