Drug prices & Part D
New Law Delays or Blocks Medicare Price Talks for Several High-Cost Cancer Drugs
The reconciliation law signed July 4 shields more orphan drugs from Medicare's negotiating program, a move the Congressional Budget Office estimates will cost 8.8 billion dollars over a decade.
By the Goodsurance editorial teamJuly 11, 2026
A week after President Trump signed the budget reconciliation law, a KFF analysis found that several widely used cancer drugs will wait longer before qualifying for Medicare's drug price negotiation program.
The new law broadens the existing orphan drug exclusion in Medicare negotiation rules. Keytruda, a cancer treatment, had its eligibility to be selected for negotiation delayed by one year, to 2027, meaning any resulting lower price would not take effect until 2029 at the earliest. Opdivo faces the same one-year delay. Three other drugs, Jakafi, Venclexta, and Darzalex, which each carry multiple orphan disease designations but no non-orphan approvals, are now excluded from the negotiation program entirely.
The new reconciliation law delays Medicare price talks for Keytruda and Opdivo, and blocks three other cancer drugs from the program entirely.
In 2023, Medicare and the approximately 70,000 beneficiaries using Keytruda spent a combined 5.6 billion dollars on that drug, with average annual out-of-pocket costs reaching around 15,000 dollars per user. Medicare and beneficiaries spent 2.0 billion dollars on Opdivo in the same year.
The Congressional Budget Office estimates the orphan drug provisions will cost the federal government 8.8 billion dollars over a decade and will translate into higher out-of-pocket costs for Medicare beneficiaries who rely on these medications.
In plain words
A new law was signed July 4, 2026. It changes which drugs Medicare can negotiate prices for. Some cancer drugs now have to wait longer before Medicare can try to get a lower price on them. Keytruda and Opdivo each have to wait one more year. Three other drugs, Jakafi, Venclexta, and Darzalex, are now fully blocked from the program. People on Medicare who take these drugs may pay more out of pocket than they would have if negotiations happened sooner. Analysts estimate this change will cost the government about 8.8 billion dollars over the next ten years.
Understand the basics first
Source: KFF
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