Overview

• Next year’s $2,100 ceiling limits out-of-pocket costs only for prescription drugs that a beneficiary’s plan covers, leaving non-formulary drugs at full price.
• The maximum Part D deductible increases to $615 in 2026, and most plans are expected to continue requiring a deductible.
• Insurers are dropping certain medications from formularies and changing pharmacy pricing or networks, so enrollees may need to switch plans or pharmacies to avoid higher costs.
• Medicare’s negotiated prices for selected brand-name Part D drugs take effect Jan. 1, including Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and insulin aspart (NovoLog/Fiasp).
• After an enrollee reaches $2,100 in out-of-pocket spending on covered drugs, catastrophic coverage begins and they pay $0 for prescriptions for the rest of the year.