
Episode #26
EP26 2027 Medicare Drug Price Trap
CMS has published negotiated maximum fair prices for 15 Medicare Part D drugs effective January 1, 2027. CMS says 5.3 million enrollees used these drugs in 2024 and projects $685 million in beneficiary out-of-pocket savings for 2027. Ozempic, Rybelsus, and Wegovy move from a $959 list price to a $274 negotiated price. For agents, the key distinction is that this is not automatically the member’s pharmacy copay. Formulary status, tier, deductible, and pharmacy still determine member cost. The Veteran and The Closer explain what not to quote and provide a client script for booking a formulary review before AEP. Produced by PSM Brokerage. Key Topics Covered 15 negotiated Part D prices Ozempic and Wegovy price changes Negotiated price versus pharmacy copay Pre-AEP formulary review script What This Means for Agents Never quote negotiated price as copay Flag affected clients before 2027 reviews Verify formulary, tier, deductible, pharmacy Book drug reviews before AEP Sources CMS — Selected Drugs and Negotiated Prices CMS source GO-DO: Build the 2027 Review Queue Export every MA-PD and standalone PDP client this week and build one 2027 formulary-review queue for anyone using a drug named in the episode. Use the counter-price warning, collect each client’s current drug list, and book the formulary review before AEP. Infographic: https://www.psmbrokerage.com/hubfs/The%20Insurance%20Producers%20Guild/IPG_EP26_Infographic.png Slides: https://www.psmbrokerage.com/hubfs/The%20Insurance%20Producers%20Guild/IPG_EP26_Slides.pdf The Insurance Producers Guild Podcast delivers intelligence for insurance agents looking to stay ahead of industry trends. Follow the show and connect with PSM Brokerage to access tools, training, and support designed to help you grow your business. Learn more: https://www.psmbrokerage.com

