Understanding the Medicare Negotiation Program
The government is preparing to negotiate prices for 15 more drugs that will take effect in 2028. This marks a major shift as the program expands to include Medicare Part B drugs—medicines often administered in clinics for serious illnesses like cancer.
What is the Medicare Drug Price Negotiation Program?
Established under the Inflation Reduction Act, this program gives Medicare the authority to negotiate prices for a limited number of high-cost prescription drugs each year. While the goal is to lower costs for the program and patients, the way these prices are set determines the future of healthcare access.
The Ripple Effect: Beyond the Price Tag
When the government sets a price, it isn't an abstract policy choice.
It influences whether your local pharmacy can keep a drug in stock and whether insurance plans decide to "prefer" one treatment over another. Without patient input, these decisions are made with incomplete information, risking the stability of patients who are finally doing well on their current treatments.
Why Patient Input Matters: Real-World Evidence
"Patient voices are a required—and essential—part of the Medicare Drug Price Negotiation process," explains Terry Wilcox, Co-Founder & Chief Mission Officer at Patients Rising. "By submitting written comments or participating in listening sessions, patients help ensure decisions reflect real-world needs, not just numbers on a page."
What CMS Needs to Hear From You
CMS looks for clear, real-world insight into how medications affect daily life. Your story becomes "patient experience evidence" when you explain:
- Why a specific medication works for you when others failed.
- How treatment stability allows you to work or live independently.
- The real-world consequences of being forced to switch or delay treatment.
Two Ways to Participate
1. Written Comments
This is the most direct way to join the official record. You don't need to be a policy expert; you just need to be honest about your journey. CMS wants to know about your diagnosis, your benefits and challenges with the medication, and any disruptions you’ve faced like insurance denials.
2. Listening Sessions
CMS holds "patient roundtables" where you can share your experience verbally with staff. These are not policy debates—they are opportunities to explain how access to your medicine affects your life and your family.
Timeline: The Path to 2028
Early 2026: Drug Selection
CMS will announce the next 15 drugs selected for negotiation. This is the starting gun for patient advocacy.
Spring 2026: The Participation Window
Written comment periods open and listening sessions are scheduled. This is when your voice must be heard to influence the final outcome.
November 2026: Final Prices Published
The government releases the negotiated prices that will eventually take effect.
January 2028: Implementation
The new negotiated prices officially take effect for Medicare patients across the country.
How Patients Rising Can Help
We are empowering patients to share their stories with confidence. We provide the tools you need to navigate this complex federal process:
- Educational Webinars: To help you understand the IRA and the negotiation timeline.
- Practical Toolkits: Step-by-step guidance on how to draft your comments.
- Preparation Support: Helping you get ready for CMS listening sessions.
Take Action: Make Your Voice Heard
Questions Every Patient Needs to Ask
❓ Is my life-saving medication on the negotiation list for 2026?
❓ How will a change in Medicare pricing affect my ability to get my infusion at my doctor's office?
❓ Have I shared my "patient experience evidence" with CMS yet?
❓ What would losing access or being forced to switch my medication mean for my daily independence?
