Medicare Part D Changes in 2026
Change 1 — $50/month Access to GLP-1 Medications
In 2026, CMS announced a new initiative to make GLP-1 medications — used to treat type-2 diabetes and, in some cases, chronic weight management — available to eligible Medicare beneficiaries at $50 per month.
What it does: Caps the monthly cost of qualifying GLP-1 prescriptions for beneficiaries who meet CMS's coverage criteria, regardless of whether they have hit their Part D deductible or out-of-pocket cap.
Who benefits: Medicare beneficiaries who take GLP-1s and currently face high out-of-pocket costs because of tiering, prior authorization, or step therapy.
What's still being finalized by CMS:
- The precise list of qualifying drugs
- The eligibility criteria (clinical and coverage)
- How Part D and MA-PD plans operationalize the $50 cost-share
How to use it: Once CMS publishes implementation guidance, your Part D or MA-PD plan will route eligible prescriptions through the $50 program automatically. Confirm with your plan if you're currently taking a GLP-1. Source: CMS press release.
Note on M3P: The Medicare Prescription Payment Plan is sometimes mis-described as a 2026 change. It actually launched January 1, 2025. See the M3P guide for details →
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 Cap Reaches Its Second Year ($2,100 in 2026)
The annual out-of-pocket cap on Part D drug costs took effect January 1, 2025, starting at $2,000. In 2026, the cap increased to $2,100 (indexed to inflation) — 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 out-of-pocket 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.