Changes are expected in 2026 due to the effects of the Inflation Reduction Act. While there are many positive changes to the Part D program, such as a new $2,100 maximum out-of-pocket cap and a new Medicare Prescription Payment Plan, the burden of these new mandated programs is being shifted over to the insurance companies. In the meantime, costs and usage have also increased.
You, the consumer, will be asked to pay more via higher deductibles, premiums, copays/coinsurance, and plan changes. If you’re surprised to see that you need to pay your drug costs a lot higher early this year compared to last year, please check out your summary plan benefits to understand your RX costs structure, or call member service to find out why. Chances are, there is a prescription deductible you must meet (usually for brand and expensive drugs) before paying a normal copay or coinsurance for the rest of the year.
I expect things will be like this for the next few years until we may see some improvement.
