02-02-26 - NASHP
by Jennifer Reck
Ahead of its February 1, 2026, deadline, CMS announced the third list of?costly drugs for which it will negotiate Medicare Maximum Fair Prices (MFPs) with manufacturers. For the first time, Medicare seeks to negotiate lower prices for drugs covered by Part B, including high-priced physician-administered drugs. Previous rounds included prescription drugs covered under Part D only, which are typically available through retail pharmacies. Negotiations for these 15 drugs will take place in 2026, with MFPs to be published in November and made effective as of January 1, 2028.
Notably, the third round of negotiations will bring the total number of MFPs to 40 drugs. MFPs negotiated in the first round of 10 drugs went into effect on January 1, 2026. MFPs published for the second round of 15 drugs?in November of 2025 will go into effect January 1, 2027.
State affordability strategies have included addressing prescription drug prices for more than a decade, and some state policymakers are interested in leveraging the federally negotiated prices beyond Medicare. For instance, Vermont's Green Mountain Care Board recently published an analysis of savings the state would have achieved from MFPs for the first round of ten drugs in Vermont in 2023. Commercial plans alone would have saved $29.9 million, with more than half of those savings coming solely from Enbrel and Stelara. A similar analysis conducted in Oregon estimated $37 million in?savings for the commercial market.
Some State Prescription Drug Affordability Boards (PDABs) are leveraging MFPs as benchmarks for upper payment limits (UPLs). In October 2025, the Colorado PDAB set the first-in-nation upper payment limit for Enbrel based on the MFP for Enbrel. The Maryland PDAB, which may set its first upper payment limit in 2026, has indicated that MFPs would serve as floors for future UPLs.
In Minnesota, the only PDAB enacted following passage of the Inflation Reduction Act that codified the Medicare Drug Price Negotiations, has statutory language requiring MFPs be used as UPLs when they are available. In addition to Enbrel, MFP drugs of interest for state PDABs include Stelara, Faxiga, Jardiance, Ozempic, Trulicity, and Cosentyx, among others.
While states can?use MFPs as UPLs with a PDAB,?states could also achieve this outside of standing up a PDAB. Stay tuned for updates to?NASHP’s model legislation on using MFPs as reference rates to learn more.