Summary: The Medicine Cabinet in Five Years
What It Costs, Who Pays, and What's Finally Shifting
Five years from now, will the medicine cabinet look different? Will the drugs be better, cost less, and will anyone be watching the whole? Better drugs are entering the pipeline. But a better drug means nothing if the person who needs it cannot afford it.
The Inflation Reduction Act’s first ten negotiated drug prices took effect January 2026, with reductions of 38 to 79%. Januvia dropped from $527 to $113 per month. Eliquis fell from $521 to $231. Ozempic’s negotiated price for 2027 is $274, down from over $1,000. The $2,100 annual Part D out-of-pocket cap means no beneficiary pays more than that for covered prescriptions. Biosimilar competition is arriving: more than ten versions of adalimumab are on the market with discounts of 50 to 85%, though adoption has been slow.
The structurally interesting development may be the furthest from the medicine cabinet itself. The ACCESS model, launching July 2026, pays providers for managing chronic conditions using technology-supported care, with payment tied to outcomes. If technology-supported care improves blood pressure control, the second blood pressure pill might become unnecessary. If continuous glucose monitoring improves diabetes management, metformin’s dose might come down. The best way to reduce the pill count may not be better pills. It may be better systems for managing the conditions the pills treat.
What has not changed: the 15-minute primary care visit, the specialist fragmentation, the absence of anyone looking at the whole medication picture. Until someone is paid to review the complete list, the pile will keep growing regardless of what any individual drug costs.