Medicare Part D Changes in 2026
Change 1 — The Medicare Prescription Payment Plan
Starting January 1, 2026, you can opt into the Medicare Prescription Payment Plan (also called the "smoothing" option).
What it does: Instead of paying large drug costs early in the year, you spread your estimated annual out-of-pocket drug costs across equal monthly payments throughout the year. Your plan handles the calculation.
Who benefits: People who take expensive brand-name or specialty drugs and face large out-of-pocket costs in January and February before meeting their deductible.
What it does NOT do:
- Does not reduce the total amount you owe — you still pay up to $2,000
- Does not eliminate the $2,000 cap (already in effect from 2025)
- Not automatic — you must opt in
How to opt in: Contact your Part D plan directly through their website or member services.
Change 2 — Medicare-Negotiated Drug Prices
The Inflation Reduction Act gave Medicare the authority to negotiate drug prices directly with manufacturers for the first time. The first 10 drugs with negotiated prices took effect in 2026:
- Eliquis (apixaban)
- Jardiance (empagliflozin)
- Xarelto (rivaroxaban)
- Januvia (sitagliptin)
- Farxiga (dapagliflozin)
- Entresto (sacubitril/valsartan)
- Enbrel (etanercept)
- Imbruvica (ibrutinib)
- Stelara (ustekinumab)
- Fiasp/NovoLog (insulin aspart)
If you take any of these, your out-of-pocket cost may be lower in 2026. Check your specific plan's formulary for your actual cost-sharing.
Change 3 — The $2,000 Cap Reaches Full Effect
The $2,000 annual out-of-pocket cap on Part D drug costs took effect January 1, 2025. In 2026, it's in its second full year — and many beneficiaries are now planning their drug spending and plan choices around it.
Key reminder: the cap applies to covered drugs on your plan's formulary. Drugs not covered, or drugs purchased outside the U.S., don't count. Full guide to the $2,000 cap →
Should You Switch Part D Plans for 2026?
The Annual Enrollment Period (Oct 15–Dec 7) is the time to compare. With negotiated prices on 10 high-volume drugs, some plans have restructured their formularies. If you take any of the 10 negotiated drugs, a side-by-side comparison is worth doing.
Frequently Asked Questions
What are the biggest Part D changes for 2026?
Three main changes: (1) the new Medicare Prescription Payment Plan; (2) Medicare-negotiated prices on 10 drugs; and (3) the $2,000 OOP cap continuing into its second full year.
How do I sign up for the Medicare Prescription Payment Plan?
Contact your Part D plan directly. You opt in through your plan, not through Medicare. The plan spreads your estimated annual out-of-pocket costs into equal monthly payments.
Does the Payment Plan reduce my total drug costs?
No. It spreads the same out-of-pocket amount across 12 monthly payments instead of large amounts early in the year. Total cost is the same.
Which drugs have Medicare-negotiated prices starting 2026?
Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog.