If you have Medicare Part D coverage or are helping a loved one navigate their prescription drug plan, it’s important to stay informed about key updates that could impact your costs and benefits. Starting January 1, 2026, Medicare Part D will undergo major changes as part of the continued rollout of the Inflation Reduction Act. These changes are designed to lower prescription drug costs and make coverage more predictable—but they could also affect how your current plan works.

Here’s a breakdown of what’s changing, how it may affect you, and what steps you can take to stay prepared.

What’s Changing in Medicare Part D?

Several structural updates will go into effect in 2026. These include:

• Annual Out-of-Pocket Spending Cap: $2,100
  One of the most significant improvements is the introduction of a $2,100 annual cap on out-of-pocket spending for covered prescription drugs. Once you reach this amount, you’ll pay nothing for covered medications for the rest of the year.This cap is a slight increase from the $2,000 limit being introduced in 2025, which will now adjust annually based on drug spending trends.
• No Cost-Sharing in the Catastrophic Phase
  Previously, even after reaching the catastrophic phase of Part D coverage, beneficiaries still had small copays or coinsurance. Starting in 2026, this phase will include no cost-sharing at all. Once you’ve spent $2,100 out of pocket, you won’t have to pay anything more for covered drugs that year.
• Annual Deductible Increases
  The standard Part D deductible will increase slightly to $615 in 2026. You’ll pay 100% of your drug costs until you meet that amount, after which cost-sharing begins.
• Medicare Drug Price Negotiation Program Begins
  Another important change is the start of Medicare’s new drug price negotiation program. In 2026, negotiated prices will apply to 10 high-cost drugs—some of which are commonly prescribed for conditions like diabetes, heart failure, and autoimmune disorders. These include medications like Eliquis, Xarelto, Jardiance, and Stelara. These negotiated prices will be reflected in Part D formularies, helping reduce costs for both plans and beneficiaries.
• New Subsidy for Selected Drugs
  A new subsidy program will also take effect. Medicare will provide a 10% subsidy to plan sponsors on selected high-cost drugs after the beneficiary reaches the deductible. This aims to reduce the financial burden on plans and encourage them to keep expensive medications accessible to members.

What Could This Mean for You?

While these changes are designed to make drug coverage more affordable, they could also impact on the way plans are designed—and what you pay each month in premiums or at the pharmacy.

For example, plan sponsors may:

• Adjust their drug formularies (which medications are covered)
• Increase premiums
• Place more medications on higher cost-sharing tiers
• Tighten prior authorization requirements for certain drugs

That’s why it’s important to review your current coverage, update your medication list, and re-evaluate your options during the Medicare Annual Enrollment Period (AEP) this fall.

What You Can Do Now

The best way to prepare for these changes is to keep your medication list up to date and work with a licensed Medicare advisor who understands your unique situation.

By reviewing your medications now, you can receive a personalized assessment to help:

• Estimate your out-of-pocket costs in 2026
• Confirm whether your current plan will still be the best fit
• Avoid surprise costs or coverage changes

Final Thoughts

The 2026 changes to Medicare Part D represent an important step forward in making prescription drugs more affordable for older adults and people with disabilities. However, these updates also make it more important than ever to stay informed and proactive.

If you have questions or need help reviewing your coverage, don’t wait. We’re here to help you every step of the way—so you can enter 2026 with confidence and peace of mind.