Written and medically reviewed by Dorcas Morak, Pharm.D
In 2026, Medicare Part D keeps its overall structure but adjusts key amounts. The annual out-of-pocket cap rises from $2,000 in 2025 to $2,100. This cap still includes everything you spend on covered drugs—deductibles, copays, and coinsurance—and once you reach it, your drug costs end for the year. This is especially helpful if you take specialty or multiple long-term medicines.
What are the Changes to the Deductible?
The standard deductible also increases, moving from $590 (2025) to $615 (2026). You’ll pay the first $615 of covered drug costs before your plan’s cost-sharing kicks in. Because most plans are signaling small premium increases tied to inflation and market trends, it’s important to actively compare plan options during open enrollment, from October 15-December 7. Review not only the monthly premium but also the deductible, copay structure, and your projected annual spending to determine which plan best fits your needs.
What Does the Change to Catastrophic Coverage Imply?
Since 2024, once you reach the catastrophic threshold, there’s no 5% coinsurance—in other words, you owe $0 for covered drugs for the rest of the year after hitting your OOP cap. That protection continues in 2026 and remains one of Part D’s most important guardrails against runaway costs. The policy works hand-in-hand with the $2,100 cap to limit financial shocks for people who need expensive or complex therapies.
Are there Changes to Vaccines and Insulin?
Part D continues no-cost coverage for ACIP-recommended vaccines, so you won’t pay copays for shots like shingles (Shingrix), pneumonia (Prevnar 20), or flu vaccines. Insulin copay caps also remain, easing costs for people with diabetes. These measures aren’t new for 2026, but remain essential for your budget.
What Drugs Part D Typically Covers (and Why Formularies Still Matter)?
Part D plans generally cover a wide range of chronic-condition medications, including:
- Diabetes: insulin, metformin, and GLP-1 therapies such as Ozempic or Trulicity, when included on a plan’s formulary
- Heart health: statins (atorvastatin, rosuvastatin) and blood-pressure medicines like lisinopril, amlodipine, metoprolol
- Respiratory: inhalers such as albuterol, Symbicort, Spiriva for COPD and asthma
How the New Deductible Affects What You Pay?
Think of the $615 deductible as your first dollars spent in 2026. You pay this out of pocket for covered prescriptions before standard cost-sharing begins. After that, pay copays or coinsurance by your plan’s tiers until you reach the $2,100 cap—then your costs stop for the rest of the year.
Scenarios during open enrollment:
- If most of your drugs are low-cost generics, pay careful attention to both premiums and which pharmacies are preferred in each plan’s network.
- If you take brand-name or specialty drugs, estimate your yearly costs by calculating from your first dollar spent to the new cap. This way, you can compare plans on total annual outlay, not just premiums.
What Drugs Are Not Covered by Part D?
Medicare Part D does not cover:
- OTC medications (ibuprofen, omeprazole)
- Lifestyle/cosmetic drugs (minoxidil, sildenafil for ED)
- Fertility treatments (Clomid, Femara for infertility)
- Most vitamins/minerals (except select prenatal or fluoride)
- Weight loss/gain medications (unless FDA-approved for another condition)
- Experimental/off-label uses without FDA approval Checking your plan’s formulary each year is crucial, especially for newer or higher-cost therapies.
What Are Smart Ways to Save On Prescriptions In 2026?
Even with Part D, prices at the counter can vary. These steps can lower your costs:
- Use the RxLess® Assurance Plan Real-Time Price Finder: Compare pharmacy prices instantly and see whether a cash discount beats your plan copay. The RxLess® Assurance Plan coupon can sometimes save you more than insurance—and it can also be used for non-covered medications (like erectile dysfunction drugs, certain vitamins, or weight-loss medicines) that Part D excludes.
- Ask about generics: For thyroid disease (levothyroxine), high cholesterol (atorvastatin), hypertension (lisinopril), and many others, generics offer the same benefit at lower cost.
- Consider 90-day supplies for maintenance medications to reduce per-dose costs. Make sure to use the day supply filter in the RxLess® app to get the most accurate pricing.
- Check manufacturer copay cards and patient-assistance programs. If you’re on Medicare, manufacturer copay cards most likely do not apply, but disease-specific foundations may help.
