Since 2021, the price of over 1,200 prescription drugs has climbed faster than the rate of inflation, making it more important than ever to review your Medicare Advantage or Prescription Drug plan annually.
What’s new for 2026? For the first time, Medicare has negotiated maximum fair prices (MFPs) for several high-cost medications. When you combine these lower prices with the permanent $2,100 annual out-of-pocket limit, your current plan might not be the most cost-effective choice anymore.
During this year’s Annual Enrollment Period (AEP), shopping isn't just about comparing premiums—it’s about seeing how your plan integrates these new federal price caps to save you money.
The Big Ten: 2026 Negotiated Drug Prices
Is your medication on the list? As part of the Inflation Reduction Act, the federal government successfully negotiated lower prices for 10 of the most common and costly drugs covered under Medicare Part D. These new prices took effect January 1, 2026:
Eliquis: Prevents blood clots
Jardiance: Treats diabetes and heart failure
Xarelto: Prevents blood clots
Januvia: Treats diabetes
Farxiga: Treats diabetes, heart failure, and kidney disease
Entresto: Treats heart failure
Enbrel: Treats arthritis and psoriasis
Imbruvica: Treats blood cancers
Stelara: Treats psoriasis and Crohn’s disease
Fiasp/NovoLog: Insulin products for diabetes
The Next Medications on the List for 2027
The savings don't stop there. Medicare has already identified the next 15 drugs slated for price negotiations, which will take effect in 2027. We’re keeping a close watch on these developments to ensure you’re always prepared for upcoming changes to your healthcare costs.
The $2,100 Cap: Why the "Donut Hole" is History
If you’ve ever struggled with the donut hole (the coverage gap), there’s great news: it’s officially a thing of the past. Starting in 2025 and continuing through 2026, the Medicare Part D structure has been simplified to protect your wallet.
Once you hit $2,100 in out-of-pocket spending for the year, you’ll pay $0 for your covered Part D drugs for the remainder of the calendar year. This is a significant shift from before, when beneficiaries had to pay a percentage of costs. For those using high-cost medications, this cap provides immediate, predictable relief.
Managing Monthly Costs: The Medicare Prescription Payment Plan
Even with a $2,100 cap, hitting that limit early in the year—like January or February—can be a strain on a fixed budget. To help, Medicare has introduced a "smoothing" option called the Medicare Prescription Payment plan.
This program allows you to opt into a payment plan that spreads your out-of-pocket drug costs across the entire year. Instead of paying a large sum at the pharmacy counter, you’ll receive a monthly bill, making your healthcare expenses much easier to manage.
Why Your Current Plan Might Not Work
The Medicare landscape is shifting rapidly. Here are three reasons why your current coverage might need a refresh:
Premium Shifts: To offset the new $2,100 out-of-pocket cap, some insurance companies may adjust their monthly premiums.
Formulary Volatility: With the introduction of negotiated prices, many plans are moving drugs to different "tiers," which can change how much you pay at the counter.
Network Changes: Preferred pharmacy networks are tightening. Your favorite local pharmacy might not be the most affordable option under your current plan next year.
How to Shop During AEP
The Medicare Annual Enrollment Period runs from October 15th to December 7th. This is your window to make sure your coverage aligns with these new federal protections. Working with licensed agents can simplify the process and perform a personalized cost-benefit analysis.
Find the Right Medicare Prescription Drug Plan for You with SelectQuote
In just minutes, we can compare Medicare Advantage plans and Prescription Drug plan options available in your area to ensure you’re getting the benefits available to you. The service is free, and there’s no obligation to enroll.
