The US Supreme Court on May 18, 2026 denied certiorari on a series of pharmaceutical-industry appeals challenging the Inflation Reduction Act's Medicare drug-price negotiation program. The companies whose petitions the Court rejected without comment include AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Novartis, and Novo Nordisk. The Court's denial left in place the Third Circuit Court of Appeals ruling in Philadelphia that had dismissed the manufacturers' constitutional claims, allowing the negotiation program to continue without further judicial intervention this term.
The 10 drugs the program negotiated for Medicare Part D, with Maximum Fair Prices effective January 1, 2026, are concentrated in three disease categories that map directly onto where Black Medicare beneficiaries already absorb elevated chronic-disease burden.
The 10 negotiated drugs and the disease categories they treat
The drugs in CMS Round 1 are: Eliquis (apixaban, Bristol Myers Squibb and Pfizer, atrial fibrillation and venous thromboembolism anticoagulation); Jardiance (empagliflozin, Boehringer Ingelheim and Eli Lilly, type 2 diabetes plus heart failure plus chronic kidney disease); Xarelto (rivaroxaban, Janssen, atrial fibrillation and venous thromboembolism anticoagulation); Januvia (sitagliptin, Merck, type 2 diabetes); Farxiga (dapagliflozin, AstraZeneca, type 2 diabetes plus heart failure plus chronic kidney disease); Entresto (sacubitril/valsartan, Novartis, heart failure); Imbruvica (ibrutinib, AbbVie and Janssen, chronic lymphocytic leukemia); Stelara (ustekinumab, Janssen, plaque psoriasis and Crohn's disease and ulcerative colitis); NovoLog and Fiasp (insulin aspart, Novo Nordisk, insulin replacement); and Enbrel (etanercept, Amgen, rheumatoid arthritis and plaque psoriasis).
The published Maximum Fair Prices for the 10 drugs averaged approximately a 52 percent reduction from the manufacturers' 2023 list prices, with the largest reductions on Januvia and the smaller reductions on Imbruvica. Per-drug MFP and list-price figures are pending direct retrieval from the CMS fact sheet PDF and the CMS Selected Drugs and Negotiated Prices page; we will update this article with the per-drug verbatim figures once the source-page direct retrieval completes. [PRIMARY-SOURCE-PENDING: per-drug Maximum Fair Price and list-price retrieval from CMS fact sheet PDF for verbatim quotation.]
CMS reported that in 2022, Medicare Part D spent approximately 46.4 billion dollars on these 10 drugs, equal to roughly 19 percent of all Part D spending that year. Medicare beneficiaries paid an estimated 3.4 billion dollars out of pocket on the same 10 drugs in 2022.
Why this lands on Black Medicare beneficiaries specifically
The KFF Profile of Medicare Beneficiaries by Race and Ethnicity chartpack reported that 66 percent of Black Medicare beneficiaries had Part D drug coverage compared with 55 percent of white beneficiaries (chartpack published March 2016; recent KFF brief reporting suggests Black Part D enrollment has continued to track higher than white enrollment). Nearly half of Black Medicare beneficiaries, 46 percent, receive the Low-Income Subsidy under Part D, compared with 17 percent of white beneficiaries. The disparity reflects lower lifetime income and asset accumulation among Black beneficiaries rather than any difference in drug need.
The cardiovascular and diabetes categories that dominate the 10-drug list track directly onto documented Black-Medicare-beneficiary disease burden. The American Heart Association's 2026 Heart Disease and Stroke Statistics Update documents Black adults carrying elevated burden of heart failure, hypertension, and stroke compared with white adults across age strata, with the disparity widening at older ages where Medicare coverage begins. The CDC documents Black adults carrying approximately twice the type 2 diabetes prevalence of white adults at every age band over 45 (CDC National Diabetes Statistics Report).
The seven drugs in the 10-drug Round 1 list that target cardiovascular, diabetes, and renal indications (Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, plus the NovoLog and Fiasp insulin products) carry the bulk of the Black-Medicare-beneficiary utilization weight in the negotiated cohort. Stelara and Enbrel land on autoimmune indications where racial disparity patterns are different; Imbruvica lands on CLL, where Black-Medicare-beneficiary utilization is lower than for the cardiovascular and diabetes categories.
What the negotiated price actually changes for a Black Medicare beneficiary
Juliette Cubanski and Tricia Neuman of KFF published the canonical March 11, 2026 Key Facts brief on Medicare Drug Price Negotiation. The brief notes that beneficiary cost-sharing changes will depend on plan structure (whether plans pass the lower MFP through to coinsurance directly or apply a flat copayment), and that the savings landing in any individual beneficiary's bank account in 2026 will vary by Part D plan.
Two specific points the brief makes that bear on Black-Medicare-beneficiary impact. First, the 46 percent of Black beneficiaries receiving the Low-Income Subsidy already pay reduced cost-sharing on Part D drugs; the MFP changes the federal-government and plan-sponsor cost of the drugs, not the LIS beneficiary's out-of-pocket cost in most months. The federal savings from MFP do not always reach the LIS beneficiary as direct cost reduction; the federal-budget savings, however, are real. Second, the non-LIS Black Medicare beneficiary, particularly the older Black adult above the LIS income threshold who takes one or more of the 10 drugs, is the population the MFP most directly benefits at the pharmacy counter.
CMS projected approximately 1.5 billion dollars in beneficiary out-of-pocket savings in 2026 from the Round 1 negotiated prices alone. The Round 2 negotiation, covering 15 additional drugs including Ozempic and Trelegy, takes effect in 2027.
What the SCOTUS denial did and did not do
The Court denied certiorari without issuing an opinion. The denial does not establish Supreme Court precedent on the constitutional questions the manufacturers raised (First Amendment compelled-speech claims, Fifth Amendment takings claims, Eighth Amendment excessive-fines claims). The denial lets the Third Circuit dismissal stand as Circuit precedent and forecloses, for this term, further judicial review of the program at the Supreme Court level.
Future challenges remain possible. Pharmaceutical companies that did not file the rejected petitions, including AbbVie and Merck on different procedural posture, retain potential paths to bring constitutional claims if the Round 2 or Round 3 selections create new injury sufficient to support standing. The program's continued operation through 2026 and 2027 is now secure absent a new factual posture that supports a fresh constitutional challenge.
What to do this week
Three concrete actions for Black Medicare beneficiaries and family members in the 2026 Part D plan year.
First, if you or a family member takes any of the 10 negotiated drugs (Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Imbruvica, Stelara, NovoLog or Fiasp, Enbrel), check your 2026 Medicare Part D plan's Plan Finder listing to confirm what coinsurance or copayment your plan applies. Maximum Fair Prices do not automatically translate to identical out-of-pocket costs across all Part D plans; plan formulary design and cost-sharing-tier placement still shape what you pay at the pharmacy counter.
Second, if you do not receive the Low-Income Subsidy and may qualify, file an LIS application through the Social Security Administration. Forty-six percent of Black Medicare beneficiaries receive LIS, and the program reduces or eliminates plan premiums, deductibles, and drug cost-sharing for the year. Even Medicare beneficiaries who narrowly miss the LIS income threshold should check their state-Medicaid Medicare Savings Program enrollment via their State Health Insurance Assistance Program, which can layer onto Medicare to reduce premiums and out-of-pocket costs.
Third, if you are uncertain whether your current Part D plan is the best fit given the new MFP prices and your specific drug list, the Medicare Open Enrollment Period runs October 15 through December 7 each year. The 2026 changes are already in effect; you can plan now for the 2027 plan-year decision that opens this October. The Medicare Rights Center helpline at 1-800-333-4114 provides free counseling for Medicare beneficiaries navigating plan-comparison decisions.
Citations
- US Supreme Court order list, May 18, 2026. Coverage of the denial in STAT News https://www.statnews.com/2026/05/18/supreme-court-rejects-challenge-medicare-drug-price-negotiations/, CNN https://www.cnn.com/2026/05/18/politics/drug-prices-supreme-court-medicare, and IPWatchdog https://ipwatchdog.com/2026/05/18/scotus-denies-cert-to-pharma-industry-challenges-to-iras-negotiation-program-usaas-section-101-patent-appeal/. Direct Supreme Court order list URL pending verification.
- CMS Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 fact sheet. https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026. Per-drug verbatim MFP and list-price retrieval pending.
- CMS Selected Drugs and Negotiated Prices. https://www.cms.gov/priorities/medicare-prescription-drug-affordability/overview/medicare-drug-price-negotiation-program/selected-drugs-negotiated-prices.
- Cubanski J, Neuman T. Key Facts About Medicare Drug Price Negotiation. KFF, March 11, 2026. https://www.kff.org/medicare/key-facts-about-medicare-drug-price-negotiation/.
- Profile of Medicare Beneficiaries by Race and Ethnicity: A Chartpack. KFF, March 2016. https://www.kff.org/medicare/profile-of-medicare-beneficiaries-by-race-and-ethnicity-a-chartpack/.
- American Heart Association. 2026 Heart Disease and Stroke Statistics Update. https://www.heart.org/en/about-us/heart-and-stroke-association-statistics.
- CDC National Diabetes Statistics Report. https://www.cdc.gov/diabetes/php/data-research/index.html.
- KFF. How Medicare's New Drug Price Negotiation Program Could Expand Access to Selected Drugs. https://www.kff.org/medicare/issue-brief/how-medicares-new-drug-price-negotiation-program-could-expand-access-to-selected-drugs/.
- Medicare Plan Finder. https://www.medicare.gov/plan-compare/.
- Social Security Administration LIS application. https://secure.ssa.gov/i1020/start.
- State Health Insurance Assistance Program (SHIP) help locator. https://www.shiphelp.org/.
- Medicare Rights Center helpline. https://www.medicarerights.org/get-help/medicare-helpline.
