07/22/2025
Alert!! We have 2026 news!! Next year is not looking too bad. Yes it would be nice to see things improve, but it could be worse!
The Medicare Part D 2026 changes:
Part D MOOP will increase from $2000 to $2100
Part D Deductible will increase from $590 to $615.
Following is the summary from the CMS link below:
In 2026, Medicare Part D is undergoing significant changes, particularly impacting cost-sharing for prescription drugs. The most notable changes include an increase to the out-of-pocket (OOP) spending threshold, changes to the cost-sharing structure in the initial coverage phase, and updates to cost-sharing for insulin and adult vaccines.
Key Changes for 2026:
• Out-of-Pocket Threshold:
The annual out-of-pocket (OOP) spending threshold will increase to $2,100, up from $2,000 in 2025. This means beneficiaries will continue to pay 25% of their prescription drug costs until they reach this threshold.
• Initial Coverage Phase:
The enrollee pays 25% coinsurance for covered Part D drugs. The sponsor typically pays 65% of the cost of applicable drugs and selected drugs and 75% of the cost of all other covered Part D drugs. The manufacturer, through the Manufacturer Discount Program (Discount Program), typically covers 10% of the cost of applicable drugs. CMS pays a 10% subsidy for selected drugs during a price applicability period. This phase ends when the enrollee has reached the annual OOP spending threshold of $2,100, for CY 2026.
• Catastrophic Coverage:
The enrollee pays no cost sharing for covered Part D drugs. Sponsors typically pay 60% of the costs of all covered Part D drugs. The manufacturer pays a discount, typically equal to 20%, for applicable drugs. CMS pays a reinsurance subsidy equal to 20% of the costs of applicable drugs and 40% of the costs of all other covered Part D drugs that are not applicable drugs, including selected drugs, during a price applicability period.
• Insulin:
Cost-sharing for a one-month supply of covered insulin products will be capped at the lesser of $35, 25% of the maximum fair price, or 25% of the negotiated price.
• Adult Vaccines:
Cost-sharing will be eliminated for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and covered under Part D.
• Deductible:
The annual deductible will be $615 for 2026, according to the Centers for Medicare & Medicaid Services | CMS (.gov).
Today, the Centers for Medicare & Medicaid Services (CMS) released the Final Calendar Year (CY) 2026 Part D Redesign Program Instructions (the Final CY 2026 Program Instructions) concurrently with the Announcement of CY 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Poli...