Medicare Part D in 2026: What’s Changing and What It Means for Your Prescriptions

Everything you need to know about new drug pricing, cost caps, and how changes to Medicare Part D could affect your out-of-pocket costs in 2026 — brought to you by MRW Solutions Group.

Elderly couple reviewing their prescription plan

Medicare Part D is the prescription drug benefit many Medicare enrollees rely on to help manage the cost of medications. In 2026, several important updates go into effect — driven largely by federal policy changes — that could change how much you pay, which drugs cost less, and how you plan for the year ahead. Understanding these changes can help you make smarter decisions during Medicare Open Enrollment and beyond.

1. New Negotiated Drug Prices Take Effect

One of the most talked-about changes for 2026 is the start of Medicare’s negotiated drug pricing program. For the first time, Medicare will directly negotiate prices with drug manufacturers for certain high-cost medications covered under Part D. These negotiated prices apply to a set of 10 prescription drugs that started January 1, 2026.

This means people with Medicare who take one of these drugs may see lower copays or coinsurance when filling prescriptions next year. The government estimates the negotiated prices could save beneficiaries and the Medicare program billions over time.

Prescription bottle

Examples of drugs on the initial negotiated list include:

• Eliquis – blood clot prevention

• Januvia & Jardiance – diabetes medications

• Farxiga & Entresto – diabetes and heart failure

• Stelara & Enbrel – autoimmune disease treatments

• Xarelto – blood clot prevention

• Insulin products like Fiasp and NovoLog 

This change is a big deal for patients with chronic conditions who take these medications regularly — even a modest reduction in price can add up to thousands of dollars saved over a year.

2. Annual Out-of-Pocket Cap Slightly Adjusted

In 2025, Medicare introduced the first hard cap on out-of-pocket prescription drug spending under Part D — protecting beneficiaries from unlimited drug costs. For 2026, that cap is being updated to $2,100. Once a beneficiary reaches this amount in a calendar year, covered Part D drugs are no longer subject to out-of-pocket costs.

This cap gives retirees and other Medicare beneficiaries greater predictability and financial protection against high medication costs — especially for those who take multiple or specialty drugs.

A wallet with a lock symbol, representing financial protection

3. Deductible and Premium Adjustments

While the out-of-pocket cap is helpful, other costs in Part D are shifting too:

• Standard Part D deductibles are expected to rise in 2026, with the maximum any plan can charge increasing from around $590 in 2025 to $615 in 2026.

  
  

• Monthly premiums for Part D plans show mixed trends; some national estimates project average Part D premiums may slightly decrease overall, although this varies by plan and region.

  
  

• Medicare Prescription Drug Extra Help Change: In 2026, Medicare’s Prescription Drug Extra Help (the Part D Low-Income Subsidy / LIS) didn’t “relaunch,” but it did update the dollar amounts people see—mainly the copays, the out-of-pocket point where copays drop to $0, and the resource limits used to qualify. These updates come from CMS’s annual LIS parameter updates and the newer Part D benefit structure being phased in.

  
  

  What you pay with Extra Help in 2026 (key changes are the 2026 dollar amounts): Medicare lists $0 plan premium and $0 deductible, with copays capped at up to $5.10 for generics and up to $12.65 for brand drugs at participating pharmacies.

  
  

  Once your total drug costs reach $2,100, you pay $0 for covered Part D drugs for the rest of the year; and if you also have full Medicaid and QMB, your copays can be lower (Medicare notes no more than $4.90 per covered drug in that situation).

  
  

  What it takes to qualify (another 2026 update): CMS set the 2026 resource limits (assets) for full LIS at $23,475 (single) / $31,725 (married), or $24,975 /$33,225 if you told Social Security you expect to use resources for burial expenses up to $1500. CMS also notes the 2026 income standards are updated each year and are released after the 2026 federal poverty level figures are issued. Practically: if you already have Extra Help, watch for annual notices/auto-enrollment letters, and make sure your plan choice aligns with LIS rules in your region (some plans can still create a premium difference depending on the plan and benchmark).

A checklist image labeled “Plan Costs to Review Each Year”

These changes reflect broader cost pressures in the healthcare system and show why it’s important to shop your Part D plan annually rather than automatically assuming your current plan is still the best fit.

4. Fewer Stand-Alone Plan Choices in Some Areas

Beneficiaries who prefer stand-alone Part D prescription drug plans will notice fewer options overall in 2026. According to recent data, the number of stand-alone Part D plans nationwide is projected to decrease significantly compared to 2025.

While the range of plan choices (8–12 per state) remains reasonably broad in most areas, shoppers should compare formularies, pricing, and coverage rules carefully — especially if the specific drugs you take are moving between coverage tiers or facing new cost-sharing rules.

5. Automatic Prescription Payment Plans Continue

For beneficiaries who prefer predictable budgeting, the Prescription Payment Plan (sometimes called smoothing) automatically renewed in 2026 unless you opt out. This option spreads your drug costs over the year instead of paying large amounts at the pharmacy each month — which can reduce financial stress for people on fixed incomes.

A relaxed senior looking at a bank app

6. Why These Changes Matter

Taken together, the 2026 Part D changes reflect a shift toward transparency, affordability, and sustainable prescription drug coverage — but they also introduce new variables:

✔ Potential savings on high-cost medications through negotiated prices

✔ Better protective caps on annual drug spending

✔ Continued options for budgeting prescription costs

✔ A landscape of Part D plans that may look different than in years past

✔ MRW Solutions Group may charge a consultation fee only when the plan you select does not pay an agent commission. Most stand-alone Medicare Prescription Drug Plans (Part D/PDP) do not pay agent commissions.

At the same time, rising deductibles and fewer plan options in some areas mean it’s more important than ever to review your Part D coverage each year.

How MRW Solutions Group Can Help You

MRW Solutions Group agent helping elderly client

Navigating Medicare Part D — especially with changes on the horizon — can feel overwhelming. That’s where MRW Solutions Group comes in:

• We help compare Part D plans based on your specific medications and budget.

• We walk you through changes to premiums, deductibles, and coverage rules.

• We help you strategize prescription benefit choices during Medicare Open Enrollment and beyond.

• Please note: MRW Solutions Group charges a consultation fee only if the plan being reviewed does not pay an agent commission. Because most stand-alone Part D Prescription Drug Plans do not pay commissions, a consultation fee may apply for PDP-only assistance only.”

  
  

👉 Contact us today to make sure your Part D coverage works as hard as you do — and that you’re getting the most value out of your Medicare benefits.