Medicare Price Talks Are Moving Toward More Arthritis Drugs: What Patients Taking Xeljanz, Orencia, Cosentyx, or Cimzia Should Know

As of April 2, 2026, nothing changes at the pharmacy yet for Medicare patients taking Xeljanz, Xeljanz XR, Orencia, Cosentyx, or Cimzia.

What has changed is that the Centers for Medicare & Medicaid Services has officially selected these drugs for the third round of Medicare drug price negotiations, and the manufacturers have agreed to participate. If negotiations lead to lower Medicare prices, those prices are scheduled to start on January 1, 2028.

That makes this an affordability story worth watching for people with Medicare. It does not mean people with job-based insurance, ACA Marketplace coverage, Medicaid, or no insurance will automatically see a change.

What changed

CMS announced on January 27, 2026 that 15 drugs were selected for the third Medicare negotiation cycle. Among them were four drugs that many people know from arthritis care:

Orencia
Cosentyx
Xeljanz and Xeljanz XR
Cimzia

Then, on March 13, 2026, CMS said the manufacturers for all selected drugs chose to participate in the process.

In plain language, the program allows Medicare to negotiate a ceiling price, called a maximum fair price, for selected high-spending drugs that meet the program rules. But the key word here is future: the negotiation process is happening during 2026, not at the pharmacy counter right now.

Why these four drugs stand out

These medicines are used for conditions that many arthritis patients and families know well. According to CMS, the four arthritis-related drugs in this cycle accounted for billions in Medicare spending over a recent 12-month period:

Orencia: commonly used for rheumatoid arthritis and psoriatic arthritis; about $2.45 billion in Medicare spending and about 72,000 Medicare users
Cosentyx: commonly used for plaque psoriasis and psoriatic arthritis; about $2.33 billion in Medicare spending and about 40,000 users
Xeljanz/Xeljanz XR: commonly used for rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis; about $1.01 billion in Medicare spending and about 22,000 users
Cimzia: commonly used for rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, and Crohn’s disease; about $786.8 million in Medicare spending and about 38,000 users

Those numbers help explain why arthritis patients, caregivers, and rheumatology clinics are paying attention. These are not niche products in Medicare.

The timeline matters more than the headline

The easiest mistake to make is to hear “Medicare negotiation” and assume lower prices are already here. They are not.

Here is the timeline readers should keep in mind:

January 27, 2026: CMS selected the drugs
February 28, 2026: manufacturers reached the deadline to decide whether to participate
March 13, 2026: CMS announced that manufacturers for all selected drugs are participating
June 1, 2026: CMS says it plans to send initial offers
Summer and fall 2026: negotiations can continue
November 1, 2026: the negotiation period is set to end
January 1, 2028: any negotiated prices would begin

So if you take one of these medicines and have Medicare, this is something to follow during 2026 and 2027. It is not a reason to expect an immediate bill change in April 2026.

Who could benefit

The people most likely to benefit are Medicare enrollees who use one of the selected drugs.

Even then, the impact will not be identical for everyone. A person’s costs can depend on things like:

whether the drug is covered under their pharmacy benefit or medical benefit
their Medicare plan design
coinsurance versus flat copays
deductibles
prior authorization rules
where the drug is given or dispensed

That is why a negotiated Medicare price does not automatically tell any one patient exactly what they will save.

What this does not guarantee yet

At this stage, patients should be careful not to assume too much.

What is known: the drugs were selected, the manufacturers are participating, and negotiations are moving ahead during 2026.

What is still unknown: the final negotiated prices, how much any specific patient might save, whether plan rules will change, and how smoothly the policy will work across different parts of Medicare.

There is a good reason for that caution. A recent cross-sectional study published in JAMA Network Open looked at about 273,774 patient-years of Medicare Advantage claims involving seven clinician-administered biologic drugs. Researchers found that out-of-pocket costs fell on average after biosimilar competition, but the size of the change depended a lot on how patients were charged, such as coinsurance versus copays. That study was not about these four specific arthritis drugs under the new Medicare negotiation cycle, so it cannot predict exact savings here. Still, it is a useful reminder that lower system prices do not always translate into the same result for every patient.

Why rheumatologists are watching the first Part B drugs in this cycle

The American College of Rheumatology has raised a separate issue that patients should understand, especially if they receive medicine in a clinic or infusion setting.

This third cycle is the first time the Medicare negotiation program includes drugs covered under Part B, which is the part of Medicare that often pays for physician-administered treatments. The rheumatology group says the reimbursement structure could create problems for infusion providers if payment does not line up well with the real costs of buying, storing, handling, and safely administering these therapies.

That is best understood as a policy concern to watch, not proof that patients will lose access. CMS has not said that patients taking these arthritis drugs will face specific access problems, and the four named drugs should not be treated as if they all have the same billing pathway or the same site-of-care issues. But the concern helps explain why specialists are following this negotiation round closely.

Why this matters beyond one drug list

Arthritis is common in the United States, so affordability questions reach far beyond a small group of patients. A recent CDC data brief found that the age-adjusted prevalence of diagnosed arthritis among U.S. adults was 18.9% in 2022. Rates were higher in women, higher in older adults, and higher among people with lower family income. Adults living in nonmetropolitan areas were also more likely to report arthritis.

That means cost changes involving major arthritis drugs can matter not only to individual patients, but also to caregivers, clinics, and communities that already carry a heavy arthritis burden.

What Medicare patients and caregivers can do now

If you or a family member takes one of these drugs, the most useful steps right now are practical ones:

Confirm whether you are taking one of the selected drugs: Orencia, Cosentyx, Xeljanz/Xeljanz XR, or Cimzia
Ask which part of Medicare covers it: Part D, Part B, or Medicare Advantage
Review whether you currently face prior authorization, coinsurance, or site-of-care limits
Do not stop or switch medication based on negotiation headlines alone
Watch for more details later in 2026 and into 2027, when CMS should release more information about the process and final prices

Bottom line

For Medicare patients taking Xeljanz, Orencia, Cosentyx, or Cimzia, this is real policy news, but it is not immediate pharmacy news.

The big development is that these drugs are now in Medicare’s third negotiation cycle and manufacturers are participating. The big limit is timing: any negotiated prices are not scheduled to begin until January 1, 2028.

So the best takeaway is simple: watch this, but do not assume your cost or access has changed yet. The questions that matter most now are whether your drug is on the list, how Medicare covers it, and whether your plan rules could still shape what you pay even after negotiations are finished.

Sources

This article is for general informational purposes only and is not medical advice. Research findings can be early, limited, or subject to change as new evidence emerges. For personal guidance, diagnosis, or treatment, consult a licensed clinician. For current outbreak or public health guidance, follow your local health department, the CDC, or another relevant public health authority.