Pharmaceutical companies are preparing to raise U.S. list prices on at least 350 branded prescription drugs next year, including vaccines for COVID-19, RSV and shingles, as well as major cancer treatments, according to new data from healthcare research firm 3 Axis Advisors.

The number of planned price increases for 2026 exceeds levels seen at the same point last year, when manufacturers outlined hikes for more than 250 medications. The typical increase is expected to be about 4%, roughly in line with this year’s adjustments. The figures do not account for rebates or confidential discounts negotiated with pharmacy benefit managers and insurers.

The planned increases come as the Trump administration continues to publicly pressure drugmakers to lower prices and align U.S. costs more closely with those in other wealthy countries, where patients generally pay far less for prescription medicines.

At the same time, a small number of drugs are slated for price reductions. Roughly nine medications are expected to see cuts, including a reduction of more than 40% for the diabetes drug Jardiance. Jardiance is jointly sold by Boehringer Ingelheim and Eli Lilly and was among the first medications selected for Medicare price negotiations, which resulted in a two-thirds reduction for the program beginning in 2026. Neither company commented on the latest planned price cuts.

Drug pricing experts say the overall pattern reflects a strategy of maintaining higher list prices while offering selective discounts behind the scenes.

“These deals are often portrayed as transformative, but they only scratch the surface of what drives high prescription drug prices in the United States,” said Dr. Benjamin Rome, a health policy researcher at Brigham and Women’s Hospital in Boston. He said manufacturers appear to be balancing public concessions with continued list-price growth, particularly affecting patients who pay cash.

Pfizer plans the largest number of increases, affecting roughly 80 drugs, including cancer treatment Ibrance, migraine medication Nurtec and COVID-19 antiviral Paxlovid. Most of Pfizer’s increases are expected to remain below 10%, though its COVID vaccine Comirnaty is set for a 15% increase. Some lower-cost hospital-administered drugs could see substantially larger percentage jumps.

Pfizer said its overall price adjustments for innovative medicines and vaccines will remain below the general inflation rate and are necessary to support research, development and rising operational costs.

Other manufacturers are also moving ahead with price increases. GSK plans to raise prices on about 20 drugs and vaccines by between 2% and nearly 9%, citing the need to fund scientific innovation. Sanofi and Novartis did not respond to requests for comment.

While drugmakers have moderated price hikes in recent years following political scrutiny and new federal policies penalizing excessive increases tied to Medicare, early January remains the most common period for list-price changes. Additional increases and reductions are expected to be announced in the coming weeks.

3 Axis Advisors, which provided the data, works with pharmacy groups, health plans and pharmaceutical-related organizations. The firm is affiliated with drug pricing nonprofit 46brooklyn and shares staff with that group.