The biggest 2026 Medicare prescription drug changes include the debut of Medicare-negotiated prices for 10 high-cost drugs, an increase in the annual out-of-pocket cap for Part D plans to $2,100, and automatic enrollment in the Medicare Prescription Payment Plan (MPPP) to spread drug costs evenly over 12 months. Additionally, the number of available stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans will decrease, and rules for Special Supplemental Benefits for the Chronically Ill (SSBCI) will change.
Cost and savings
- Negotiated drug prices: In 2026, 10 high-cost drugs will be the first to have their prices negotiated by Medicare. This is expected to lead to savings for beneficiaries. For example, the 30-day supply of Eliquis is projected to drop from $521 in 2023 to $231 in 2026.
- Out-of-pocket cap: The maximum amount you will pay out-of-pocket for covered drugs in a Part D plan is increasing to $2,100 in 2026, up from $2,000 in 2025, and CMS has set it at $2,400 for 2027. Once this cap is reached, Medicare will cover 100% of the cost of your covered drugs for the rest of the year.
- Prescription Payment Plan (MPPP): You will be automatically enrolled in the MPPP in 2026, which allows you to spread your Part D costs evenly across the year, avoiding large upfront payments.
- Deductible increase: The maximum Part D deductible will increase to $615 in 2026 from $590 in 2025, and CMS has set it at $700 for 2027.
Plan availability and benefits
- Fewer plan choices: The number of stand-alone Prescription Drug Plans (PDPs) will decrease by about 22% in 2026, and the number of Medicare Advantage Prescription Drug (MA-PD) plans will also drop by 9%.
- Changes to SSBCI: Rules for Special Supplemental Benefits for the Chronically Ill (SSBCI) in Medicare Advantage plans are changing, with a crackdown on non-health-related benefits like gift cards for groceries and alcohol.
- Insulin costs: Insulin remains capped at $35 per month, with no deductible.
Comments
0 comments
Please sign in to leave a comment.