💊Annual Medicare Drug Plan Changes – What You Need to Know 💊

Medicare’s drug coverage rules and regulations continue to change under the Inflation Reduction Act. Here are some key updates for 2026 that affect your options for prescription drug coverage bundled with a Medicare Advantage or stand-alone Part D plan with any insurance companies.  This includes formulary changes, increased costs and less extras for everyone.

Key 2026 Changes

  • $2,100 yearly cap: Beginning Jan 1, 2026, your annual out-of-pocket costs for covered Part D prescriptions are capped at $2,100 (premiums not included).

  • Deductible increase: The standard Part D deductible rises to $615 in 2026 (up from $590 in 2025).  

  • Medicare sets lower prices on select high-cost drugs with newly negotiated drug prices:
    2026 (10 meds) Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp.

Key 2027 Changes

  • $2,400 yearly cap: Beginning Jan 1, 2027, your annual out-of-pocket costs for covered Part D prescriptions are capped at $2,400 (premiums not included).

  • Deductible increase: The standard Part D deductible rises to $700 in 2027 (up from $615 in 2026).  

  • Medicare sets lower prices on select high-cost drugs with newly negotiated drug prices:
    2027 (15 meds) Ozempic, Wegovy, Rybelsus, Trelegy Ellipta, Xtandi, Pomalyst, Ofev, Ibrance, Linzess, Calquence, Austedo (XR), Breo Ellipta, Xifaxan, Vraylar, Tradjenta, Janumet (XR), Otezla

What This Means for You

  • If you take expensive medications, the new yearly cap offers protection from runaway costs for covered medications.

  • If you are in a Medicare Advantage plan (MAPD), these changes apply to your drug coverage just like stand-alone Part D (PDP).

  • If you receive Extra Help in 2026 (LIS), your copays remain low: up to $5.10 for generics and $12.65 for brands.

  • Payment plan option: If you used the Medicare Prescription Payment Plan and stay in the same plan, you’ll be automatically re-enrolled for the incoming year.

  • If you switch plans, you’ll need to re-enroll in the Payment Plan if you want to spread your drug costs across the remainder of the year.

📌📊Annual Enrollment Period: October 15 - December 7 📊📌

🔍Action Steps: Medications + Pharmacies 🔍

  1. Verify your medications are still covered.

  2. Check for any changes in tiers, prior authorizations, or cost-sharing.

  3. Review how these costs apply before you reach the annual cap (premiums not included)

Unlike Medicare Supplement (Medigap) plans, Part D and Medicare Advantage plans are annual contracts. Typically, these renew automatically into a version reflecting changes that meet the Inflation Reduction Act mentioned above and a new cost structure and list of medications for the next year.

During annual enrollment you may submit an application to change your stand alone Part D prescription drug plan or join or change a Medicare Advantage plan for the upcoming year.

⚠️Important: You must apply for your own stand-alone Part D plan, but for Medicare Advantage Plans, please contact your agent to enroll. Enrolling for a Medicare Advantage plan directly on Medicare.gov will remove compensation and my services, meaning I won’t get to be your agent any more unless you have your Advantage or Medigap plan submitted through me as your agent of record. So, thank you for your support in this win:win situation!