Four large pharmaceutical manufacturers, despite ongoing legal challenges, have agreed to participate in Medicare price talks ahead of the Oct. 1 deadline to notify the Centers for Medicare & Medicaid Services.

Although participation in the negotiation program is voluntary, companies that don't participate have to pay a major excise tax or withdraw entirely from the Medicare and Medicaid programs. At least nine different lawsuits have been filed over the negotiations and the law, including suits by several companies whose drugs are in the first list of 10, arguing that it's unconstitutional.

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