2026 Prescription Drug Plans

The Inflation Reduction Act (IRA) offered many improvements to Medicare Part D coverage, and the following are highlights that will be in place for the 2026 plan year.  

Please Note: the actual drug plan options and 2026 benefits will be available for review beginning October 1, 2025.  

• You pay 100% of the drug costs (if applicable) until you reach your annual deductible.
• We expect most plan deductibles to be $615 (up from $590 in 2025), but some plans may have lower or $0 deductibles.  
• Insulin and ACIP vaccines covered by your plan are always excluded from the deductible.
• Keep in mind, plans with lower deductibles typically have higher monthly premiums and do not guarantee lower out of pocket costs.

• You'll pay no cost-sharing (copays or coinsurance) for the remainder of the year on covered Part D drugs when you reach the $2,100 in TROOP (true out-of-pocket)  
• In 2026, you'll have the option to pay out-of-pocket costs in monthly installments over the plan year, instead of when they happen (see section below).

The new Inflation Reduction Act (IRA) updated what counts towards True out-of-pocket (TrOOP) costs in 2026.  TrOOP includes costs you pay out of pocket (e.g., your deductible, copays, and coinsurance) and some payments made on your behalf.   

• TrOOP costs are important because they determine when catastrophic coverage will begin. 
• The drug plan keeps track of each member’s TrOOP costs and will provide a monthly explanation (EOB) that shows TrOOP costs to date.
• Premium payments do not count towards TrOOP.

Most drug plans will release their 2026 plan benefits to the public by late September 2025. 

Medicare has negotiated and finalized drug pricing directly with manufacturers for the following high-tier medications.  Prices for the following 10 drugs will likely be effective Jan 1, 2026.  More info available here.  

• Eliquis
• Jardiance
• Xarelto
• Januvia
• Farxiga
• Entresto
• Enbrel
• Imbruvica
• Stelara
• Fiasp; Fiasp FlexTouch; Fiasp PenFill; Novolog FlexPen; Novolog PenFill

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Under the Inflation Reduction Act, covered insulin receives reduced cost-sharing for many Medicare beneficiaries.  

• Insulin cost-sharing is capped at $35 per 30-day supply

• A 3-month supply of covered insulin should be no more than $105

• You do not have to pay a deductible for Part D and Part B-covered insulin

• Insulins will drop to $0 cost-share in the catastrophic tier

The Medicare prescription payment plan is a new payment option that spreads your drug costs over the course of the calendar year.    

• You can spread the out-of-pocket costs for prescription medications into monthly payments over the course of the plan year (the payment plan does not lower your Part D drug costs or save you money).    
• You’ll no longer pay the pharmacy. You will receive a monthly bill from your drug plan and pay the plan directly.  
• You need to enroll in the payment plan by opting in with your plan provider.
• You will also receive a separate bill for your monthly premium if you have one.
• This program may not be a good fit if your Part D drug costs are low and/or consistently the same each month.