10/13/2025
Big Changes Coming to Medicare Part D in 2026
Medicare beneficiaries with Part D prescription drug coverage will see major changes in 2026, thanks to continued implementation of the Inflation Reduction Act.
Here’s what you can expect:
1. Out-of-Pocket Costs Capped at $2,100
Once you hit this cap, you’ll pay $0 for covered prescription drugs for the rest of the year—no coinsurance, no copays.
2. Medicare Will Begin Negotiating Drug Prices
Starting Jan. 1, 2026, Medicare will roll out negotiated prices for 10 high-cost drugs, including: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog.
3. Monthly Payment Option
Starting in 2026, if you enroll in the Prescription Payment Plan (Medicare's plan that lets you spread out drug costs over the year), you will automatically be enrolled in the program the following year.
4. Insulin and Vaccine Cost Caps Continue
The insulin cap in 2026 will be the lowest of $35, 25% of negotiated price, or 25% of maximum fair price, CDC-recommended adult vaccines (like shingles and Tdap) stay free with no copay or deductible.
5. Stricter Limits on Price Hikes
Manufacturers face penalties for raising prices faster than inflation, helping to stabilize drug costs and plan premiums.
Looking ahead:
More drugs will be added to the negotiation list each year, with up to 60 covered by 2029.
Need help understanding how these changes may affect your plan—or your clients? Let’s connect.
