Medicare drug price negotiations expand to up to 20 drugs per year under the Inflation Reduction Act

Beginning in 2029, the IRA allows CMS to negotiate up to 20 drugs per year, up from 15. The annual negotiation cadence continues indefinitely under current law. The OBBBA's orphan drug exclusion expansion reduces the eligible pool but doesn't eliminate the program. CMS projects cumulative Medicare savings of $100B+ from 2026 through 2031.