2027 Medicare Part D Changes: What Pharmacies Need to Know Before January 1

2027 Medicare Part D at a glance

The figures below are the ones most likely to affect a pharmacy's revenue, patient conversations, and cash position in 2027.

Sources: CMS, KFF, Kiplinger, AMCP.

Key dates for pharmacies

• October 1, 2026CMS publishes 2027 plan information. Pharmacies can see next year's prices for the first time.
• October 15 to December 7, 2026Medicare Open Enrollment. Patients compare and switch Part D and Medicare Advantage plans.
• January 1, 2027New plans, prices, cost-sharing, and 15 additional negotiated prices take effect.
• January 1, 2028Federal PBM reform for Medicare Part D takes effect (delinking and rebate pass-through).

The window between October 1 and January 1 is the only time a pharmacy can see the next year's prices before they show up in claims. Pharmacies that use it can adjust purchasing, staffing, and patient outreach before the new year starts.

15 more drugs with Medicare negotiated prices in 2027

Under the Medicare Drug Price Negotiation Program, CMS announced negotiated prices for 15 more drugs on November 25, 2025. They take effect January 1, 2027, alongside the first 10 drugs that started in 2026: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp. CMS estimates the new round saves about $12 billion, a 44% net reduction from 2024 Medicare spending on these products. source

Source: AMCP summary of CMS's IPAY 2027 negotiated prices. Prices are as published by CMS for the unit basis CMS used; actual claims depend on package size and quantity.

Why this round matters more at the counter: the 2027 list includes high-volume retail drugs (semaglutide, Trelegy, Breo, Linzess, Janumet, and Tradjenta) as well as specialty oncology drugs. More of a typical community pharmacy's Medicare claims will run through the negotiated-price process.

A note on GLP-1s

Semaglutide's negotiated price is $274, but GLP-1 pricing in Medicare is also shaped by other federal arrangements. NCPA reported that a separate "most-favored-nation" price for covered GLP-1s ($245) is expected to supersede the negotiated price. source In addition, a temporary Medicare GLP-1 Bridge program, which began July 1, 2026, covers certain GLP-1s for weight management outside the standard Part D benefit with a $50 copay and central prior authorization. source Pharmacies should confirm how each GLP-1 claim adjudicates rather than assume a single price.

The cash-flow problem: how MFP refunds work

Negotiated prices change how a pharmacy gets paid, not just how much:

1. The pharmacy buys the drug at its normal acquisition cost.
2. The Part D plan reimburses the pharmacy based on the negotiated (maximum fair) price.
3. Claims data flows through the Medicare Transaction Facilitator (MTF) to the manufacturer.
4. The manufacturer refunds the difference. By default that's the wholesale acquisition cost minus the MFP, times quantity, expected within 14 days of the manufacturer receiving the claims data. CMS Covington

Until step 4 happens, the pharmacy is carrying the difference. In practice, 2026 refunds have often taken longer than expected. In a survey NCPA shared with CMS in February 2026: source

An illustration of the float. Using semaglutide's 2024 list price ($959) as a stand-in for acquisition cost and its $274 negotiated price, a pharmacy carries roughly $685 per fill until the refund arrives. At 100 fills a month with a three-to-four-week refund cycle, that is around $68,500 outstanding at any time, for a single drug. Your actual exposure depends on your acquisition cost, volume, package sizes, and how each claim adjudicates.

Illustrative calculation only, based on published 2024 list prices; not a prediction of any pharmacy's results.

Fewer plans, more switching

The stand-alone Part D market keeps shrinking. According to KFF, the average beneficiary can choose from 9 stand-alone drug plans in 2027, down from 11, the fourth straight annual decline. Nationwide, plans fall from 360 to 316 and sponsors from 17 to 15. Health Care Service Corporation is withdrawing HealthSpring Extra Rx from 22 regions and CVS Health is withdrawing SilverScript Choice from 13. source

Premiums are moving too. With the premium stabilization demonstration ending after 2026, CMS set the 2027 base beneficiary premium at $41.33, held to a 6% increase by statute. source KFF reports that enrollees in AARP Medicare Rx Preferred face increases of $50 or more a month in every state, and that no zero-premium stand-alone plans are available to beneficiaries without the Low-Income Subsidy. About 4 million people who paid no premium in 2026 will now pay one. source

What it means for pharmacies: plan exits and premium jumps push patients to switch plans during Open Enrollment. Each switch can change what your pharmacy is paid for the same drug, because Part D prices are specific to each pharmacy, plan, and drug. A pharmacy's 2027 payer mix may look quite different from 2026.

What changes for patients

• Out-of-pocket cap: $2,400 in 2027, up from $2,100. source
• Deductible: up to $700, from $615. Expect more patients with higher costs at the counter in the first months of the year.
• Premiums: modest average increases, but large jumps for some popular plans, especially for patients who don't switch.

Patients will ask their pharmacist about these changes. A short, plain-language handout for Open Enrollment builds trust and helps keep patients in plans your pharmacy is in network with.

PBM reform: what's coming in 2028

The Consolidated Appropriations Act, 2026, signed February 3, 2026, includes the most significant federal PBM reform to date. For Medicare Part D, starting January 1, 2028, PBM compensation must be a flat bona fide service fee rather than tied to drug prices or rebates, manufacturer rebates must be passed through to plan sponsors, and PBMs must report drug-level data to HHS. source

None of this changes 2027 reimbursement directly, but it will reshape plan and PBM economics starting in 2028. Use 2027 to build a clean baseline of your Part D reimbursement by plan, so you can measure what changes.

Pharmacy checklist before January 1, 2027

1. Compare 2026 and 2027 prices for your top Medicare drugs across the plans your patients use, and flag the biggest declines.
2. Confirm MTF enrollment and banking details so manufacturer refunds reach the right account.
3. Size your refund float for the 25 negotiated-price drugs using your own volumes and acquisition costs, and set aside working capital.
4. Set up weekly MFP reconciliation that matches refunds to claims and tracks anything outstanding past 14 days.
5. Review inventory of high-cost negotiated-price drugs to avoid carrying excess stock into January.
6. Reach out to patients in exiting or high-premium plans during Open Enrollment, before December 7.
7. Talk to your PSAO about 2027 network participation and any contract changes.
8. Prepare staff with talking points on the $2,400 cap, the $700 deductible, and GLP-1 coverage questions.

Frequently asked questions