The US government has selected 15 high-spend medicines for the next round of Medicare price negotiations, increasing pricing pressure on pharmaceutical companies with significant exposure to the public healthcare market.

The list includes major HIV and arthritis treatments, such as Gilead’s Biktarvy and Pfizer’s Xeljanz, along with other high-value drugs used in cancer and immune-related diseases. These products are among the largest contributors to Medicare spending and will now be subject to negotiated pricing.

This is the third cycle of negotiations under the Inflation Reduction Act, and for the first time includes drugs covered under both Medicare Part D and Part B, expanding the scope of government price controls to more specialty and biologic medicines.

Negotiations are scheduled to begin in 2026, with new prices taking effect from 2028. The selected drugs accounted for around $27 billion in Medicare spending, highlighting the revenue exposure for originator companies.

The move signals continued expansion of US drug price regulation, with direct implications for pricing strategies, margins and long-term revenue planning for global pharmaceutical manufacturers.

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