Analyses spell out Medicare's $274 negotiated 2027 price for semaglutide

Starting January 1, 2027, Medicare's second round of drug price negotiations sets a $274 maximum fair price for a 30-day supply of the semaglutide group that includes Ozempic, Wegovy and Rybelsus, down from a reference price of about $959.^[1][2] The figure comes from the Centers for Medicare & Medicaid Services, which negotiates by ingredient and dosage form rather than by brand, so the same $274 applies whether a doctor prescribes Ozempic for diabetes or Wegovy for weight management.^[2] For one commonly used Ozempic pen, CMS calculated a more specific maximum fair price of $276.78.^[1]

Semaglutide is one of 15 drugs reaching negotiated prices on the same date, alongside medicines such as Trelegy Ellipta, Xtandi, Ibrance, Ofev and Otezla.^[2] Manufacturers that decline to negotiate face a steep excise tax on U.S. sales, which is why participation has become close to mandatory since the first round of negotiated prices took effect in 2026.^[2]

The negotiated price is what Medicare pays the manufacturer, not what a beneficiary hands over at the pharmacy. Part D plans still set tier placement, coinsurance, deductibles, and rules like prior authorization or step therapy, and CMS says it will review formularies for practices that undermine access, but plans keep considerable control over the final bill.^[1] One analysis estimates that a beneficiary in the standard 25% coinsurance phase could see a copay near $69 once the $274 price applies, down from roughly $240 today, though the exact number depends on each plan's design.^[2]

The sources give different figures for the 2027 Part D benefit structure. One puts the annual deductible at $700 and the yearly out-of-pocket cap on covered drugs at $2,400.^[1] The other cites a $2,100 out-of-pocket threshold tied to the Part D redesign.^[2] That gap is not resolved in the reporting reviewed here, so the precise 2027 out-of-pocket cap is not yet clear from these accounts.

A separate, temporary program complicates the picture further. Since mid-2026, a Medicare pilot has offered Wegovy specifically for weight-loss use at a flat $50 monthly copay for beneficiaries who meet body mass index and comorbidity criteria, running through December 31, 2027, alongside rather than instead of the negotiated price.^[1][2] Someone using semaglutide for type 2 diabetes moves through the standard Part D benefit and the new $274 price, while someone using Wegovy strictly for weight loss under the pilot pays the flat $50 copay regardless of the negotiated price.^[2]

Why it matters for patients

For Medicare beneficiaries filling these prescriptions, the headline number is not the number that shows up at the pharmacy counter. A lower negotiated price can shrink a copay, particularly for plans that charge coinsurance as a percentage of the drug's cost, but the size of that reduction depends on each plan's specific 2027 formulary, deductible and cost-sharing tier.^[1] Because a lower drug price also slows how quickly total spending reaches the annual out-of-pocket cap, some beneficiaries may take longer to reach the point where a plan covers 100% of costs for the rest of the year, even as their per-fill cost falls.^[2] Which coverage path applies—standard Part D for diabetes treatment, a covered weight-management use, or the temporary $50 pilot—also produces different bills for the same drug.^[1][2]

What happens next

Medicare's negotiated price takes effect January 1, 2027, and is described as permanent unless adjusted in a future negotiation cycle.^[2] Beneficiaries can compare specific 2027 plan costs during Medicare's open enrollment period, which one source lists as running October 15 through December 7, by checking a plan's Annual Notice of Change for the exact copay, tier and any prior-authorization rules attached to semaglutide.^[1] The $50 Wegovy pilot is explicitly temporary and is scheduled to run through December 31, 2027, with no confirmed plan yet for what replaces it.^[1][2]