Savings Table:

Note: Costs vary by dosage and pharmacy; check with your provider.

These savings are significant, especially with the new $2,000 Part D out-of-pocket cap (see below), making 2026 a landmark year for affordability.

• Selection: CMS identified 10 drugs based on high spending and lack of generic alternatives (e.g., Imbruvica, Stelara).
• Negotiation: Starting 2023, CMS worked with drug companies, finalizing 2026 prices by September 2025.
• Implementation: Discounts apply January 1, 2026, with 15 more drugs targeted by 2027 and 20 by 2029.
• Legal Backing: Manufacturers must comply or face penalties, ensuring savings reach beneficiaries.

• Check Your FormularyEnsure the negotiated drugs are on your plan’s 2026 formulary (drug list). Log into Medicare.gov or call your insurer to verify.
• Example: If you take Eliquis, confirm it’s Tier 2 or 3 for lower copays.
• Use the Plan Finder ToolVisit Medicare.gov/plan-compare and enter your ZIP code, drugs, and pharmacy. Compare plans with the lowest total costs, factoring in premiums (~$38/month average) and deductibles (up to $545).
• Tip: Select a plan with a $0 or low deductible to maximize savings.
• Understand the $2,000 Out-of-Pocket CapStarting 2026, your total Part D out-of-pocket costs (copays, coinsurance) are capped at $2,000 annually. After this, catastrophic coverage (100% drug coverage) applies.
• Example: If you spend $3,000 on Imbruvica, you’ll pay $2,000, saving $1,000.
• Appeal Denials or Prior AuthorizationsIf a negotiated drug is denied, request a coverage determination or appeal. Include a doctor’s letter explaining medical necessity.
• Switch Plans if NeededIf your current plan doesn’t cover a negotiated drug well, switch during Open Enrollment (ends December 7, 2025). Changes take effect January 1, 2026.