The new year will bring key changes to Medicare Part D prescription drug coverage. With lower prices for select prescriptions and new out-of-pocket costs, there’s a lot to tell your clients about.
2026 Medicare Part D Costs and Plan Options
There are 360 Medicare Part Prescription Drug plans in 2026, down from 464 in 2025, according to KFF. The number of Medicare Advantage plans has also decreased by 9%, with 3,373 plans available in 2026, according to KFF.
Despite the decrease in options, CMS says Medicare Part D and Medicare Advantage plans are fairly stable going into 2026, and average premiums have dropped. In 2026, the average monthly premium for Medicare Advantage is $14.00, down from $16.40 in 2025, and the average Medicare Part D monthly premium is $34.50, down from $38.31 in 2025. KFF says some plans have decided to raise costs, but only a few raised costs by $50, which is the maximum increase allowed.
Some enrollees may also see higher premiums due to the Medicare Income-Related Monthly Adjustment Amount. In 2026, the Part D IRMAA is $83.30 for beneficiaries who are married but filed separate tax returns and earned between $109,000 and $391,000, and $91 for beneficiaries who earned more than that.
In Texas, prices are down and plan options have actually increased, bucking the national trend. CMS says the average Medicare Advantage monthly premium has decreased from $6.14 in 2025 to $4.35 in 2026. There are 426 plans available in 2026, up from 381 in 2025. There are 4,857,268 Medicare enrollees in the state, and all of them have access to at least one Medicare Advantage plan, including a plan with a $0 premium.
Lower Prices for Select Prescriptions
Medicare beneficiaries will finally see savings from Medicare drug negotiations starting in 2026. Back in 2022, the Inflation Reduction Act paved the way for Medicare to negotiate with drug companies to secure lower prices for high-cost prescription drugs.
The first round of negotiated prices covers 10 drugs. CMS says 8.8 million Medicare Part D beneficiaries took at least one of these 10 prescriptions in 2023, and the negotiated prices are expected to result in savings of $6 billion total, including $1.5 billion in out-of-pocket savings.
The 10 drugs with negotiated prices set to take effect in 2026 are:
- Januvia for diabetes
- Fiasp and NovoLog (also Fiasp FlexTouch, Fiasp PenFill, NovoLog FlexPen and NovoLog Pen-Fill) for diabetes
- Farxiga for diabetes, heart failure, and chronic kidney disease
- Enbrel for rheumatoid arthritis, psoriasis, and psoriatic arthritis
- Jardiance for diabetes and heart failure
- Stelara for psoriasis, psoriatic arthritis, Chron’s disease, and ulcerative colitis
- Xarelto to prevent and treat blood clots and reduce risk of artery disease
- Eliquis to prevent and treat blood clots
- Entresto for heart failure
- Imbruvica for blood cancers
This is just the first round of negotiations, and the second round has already been announced. CMS has negotiated lower prices for 15 more prescription drugs. In 2024, 5.3 million Medicare Part D enrollees too these drugs, and the lower costs are expected to result in savings of $12 billion, including $685 million in out-of-pocket savings. Medicare enrollees who have diabetes type 2 or who need to lose weight may be happy to learn that Ozempic, Rybelsus and Wegovy are included on the list. The second round of lower prices will go into effect in 2027.
What If Your Clients Can’t Afford Their Prescriptions?
If your clients are struggling to afford their Medicare prescription coverage, encourage them to apply for financial assistance. They can apply for a Texas Medicare Savings Program by contacting Texas Health and Human Services. Even if they don’t qualify for a Medicare Savings Program, they may qualify for Extra Help with their prescription coverage. They can apply for Extra Help through the Social Security Administration.
Medicare enrollees who can typically afford coverage but are hit with unexpected out-of-pocket costs for pricy medications have a new option. Instead of paying the full out-of-pocket amount upfront at the pharmacy, they can receive their medication immediately without paying and then make monthly payments. Although the Medicare Prescription Payment Plan does not decrease the amount they pay, it does allow them to get the medication they need without delay.
Do you have questions about Medicare changes and how you can serve your clients? Contact PTT Financial.