By Patricia Prewitt
My Personal Rx Adviser
The Inflation Reduction Act of 2022 was designed to lower drug costs, expand coverage, and improve the sustainability of the Medicare program for years to come. At the time of this article, the law remains in place.
What are the new costs for 2026 for Medicare enrollees when it comes to prescription coverage?
Increased deductibles: The maximum annual deductible for Part D Medicare prescription drug plans is expected to rise from $590 to $615 in 2026.
Increased out-of-pocket limits: The out-of-pocket maximum for covered medications increases slightly to $2,100 annually. It remains that if your medication is not covered, or not on Prescription Drug Plan Formulary, your costs may be higher and not be applied to this cap. This generally happens for “lifestyle” prescriptions.
What is expected to remain the same?
Insulincosts for covered insulin products is capped at $35 a month or less.
Spread-out drug payment option continues: If you enrolled in 2025, you will be automatically re-enrolled for 2026. This allows Medicare subscribers to spread annual costs over 12 months, rather than pay a lot all at once in early in the year to meet the $615 annual deductible. It works like setting up a budget plan for utilities, making payments easier on a fixed income.
I’ve heard prices may be going down for certain medications. What are they?
Under the Inflation Reduction Act of 2022, Medicare was allowed the ability to negotiate prescription prices of certain high-expenditure, single-source drugs without generic or biosimilar competition at that time. The Centers for Medicare and Medicaid Services (CMS) estimates overall impact (according to data pulled from the time period from Jan 1 – Dec 31, 2023) is to lower out-of-pocket costs for 8.8 million Medicare subscribers. The first 10 medications with lower prices fall in the therapeutic areas of cardiology, diabetes, immunologic disorders, and blood cancers.
The following prices are due to go into effect for 2026. All prices are stated as a 30-day supply. CMS Medicare Drug Price Negotiation Program Link: https://www.cms.gov/files/document/fact-sheet-negotiated-prices-initial-price-applicability-year-2026.pdf.
Cardiology related medications: Xarelto (rivaroxaban) $197; Eliquis (apixaban) $231; Entresto (sacubitril/valsartan) $295.
Diabetes-related medications: Januvia (sitaliptin) $113; NovoLog Flex pens/various $119; Farxiga (dapagliflozin) $178.50: Jardiance (empagliflozin) $197.
Immunological conditions: Enbrel (etanercept) $2,355; Stelara (ustekinumab) $4,695.
Blood cancers: Imbruvica (ibruvicahcp) $9,319
Important to Note: Some of the medications on this list may have generic versions become available during 2026. It is not known how various Medicare Part D prescription drug plans may respond to those market changes.
Content provided is for educational purposes only and is not intended as a substitute for advice from a qualified medical professional. The opinions expressed within are those of the author.
About the Author: Patricia Prewitt is a local Massachusetts resident who spent more than 30 years in the pharmaceutical industry. Tricia is a consumer education advocate, and loves helping people find ways to save money on their prescriptions. More information and free resources are available on her website at https://mypersonalrxadvisor.com/resources or call her at 508-507-8840. Favorite Quote: “Act as if what you do makes a difference. It does.” – William James
