3 Big Medicare Prescription Drug Changes Coming in 2026

“Equally important, Medicare-negotiated drug prices will help lower Part D enrollee costs and provide millions of older Americans with much-needed financial relief,” the report says.

The new lower prices must be made available to all eligible beneficiaries. All Medicare Advantage plans with drug coverage and stand-alone Part D drug plans for beneficiaries in original Medicare must list them as part of their formularies.

Negotiated lower prices on 15 additional drugs are expected to save $8.5 billion to $12 billion a year for Part D enrollees when they take effect in 2027, the federal Centers for Medicare & Medicaid Services (CMS) says.

For 2028, up to 15 Part D- or Part B-covered drugs will be selected for price negotiation. That number could rise to 20 for 2029 and later years .

2. Out-of-pocket drug costs will be capped at $2,100

Part D enrollees will face a $2,100 cap on annual out-of-pocket prescription drug expenses in 2026, up from $2,000 in 2025, when the cap was introduced.

The $100 increase, a 5 percent hike, reflects what will be an annual adjustment to the Part D benefit. The 2026 amount is based on the percentage increase in average spending for covered Part D drugs that occurred in 2024.

The maximum Part D deductible will also increase in 2026, to $615, up from $590 in 2025. Some Part D plans will have lower deductibles or none at all.

Both the out-of-pocket cap and the maximum Part D deductible are adjusted each year. The cap, which limits enrollees’ cost exposure, results from a provision in the AARP-backed prescription drug law signed in 2022.

For years, Part D plans had no ceiling on out-of-pocket spending. This, combined with rising drug prices, caused many older Americans with high drug costs to skip doses or miss prescription refills. Nearly half of people polled in an AARP survey reported not filling a prescription because of its cost or knowing someone who has done so.

In 2025, the first year with an out-of-pocket Part D spending cap, nearly 3.2 million Americans are expected to save money on prescription medications, according to research that AARP commissioned.

By 2029, more than 4 million people with a Medicare drug plan who do not receive the program’s low-income subsidy will hit the annual ceiling and see savings when they go to fill their prescriptions, according to a recent AARP report.

3. Medicare to cut cost of popular weight-loss drugs

Medicare beneficiaries enrolled in Part D prescription plans through either original Medicare or Medicare Advantage will see trendy GLP-1 weight-loss drugs available at $50 a month for those who qualify. A White House agreement with manufacturers Eli Lilly and Novo Nordisk was announced in November.

The CMS bridge program, which won’t require meeting any deductibles, will run July to the end of December in advance of a Part D pilot program targeting obesity that will begin in 2027. Private insurers must decide by Jan. 8 whether to opt into covering the medications, so Medicare enrollees will be able to use that information to shop for plans during open enrollment Oct. 15 to Dec. 7.  

Injectables Mounjaro, Ozempic, Wegovy and Zepbound as well as a Wegovy pill that the FDA approved are expected to be covered.

In addition to helping with weight loss, GLP-1s, or glucagon-like peptide-1 receptor agonists, have been found to improve heart and liver health and treat sleep apnea in overweight adults. They’ve also been shown to reduce complications from kidney disease and even protect the brain.

Doctors have been prescribing GLP-1s for weight loss because studies have found that losing 5 percent to 10 percent of your weight can have positive effects on your health.

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Join our fight to protect Medicare

AARP is working to keep Medicare strong. Here’s how you can help.

• Sign up to become an AARP activist for the latest news and alerts on issues you care about.
• Find out more about how we’re fighting for you in Congress and across the country.
• See the latest AARP research on Medicare and more.
• AARP is your fierce defender on the issues that matter to people 50-plus. Become a member or renew your membership today. 

Join our fight to protect Medicare

AARP is working to keep Medicare strong. Here’s how you can help.

• Sign up to become an AARP activist for the latest news and alerts on issues you care about.
• Find out more about how we’re fighting for you in Congress and across the country.
• See the latest AARP research on Medicare and more.
• AARP is your fierce defender on the issues that matter to people 50-plus. Become a member or renew your membership today. 

Join our fight to protect Medicare

AARP is working to keep Medicare strong. Here’s how you can help.

• Sign up to become an AARP activist for the latest news and alerts on issues you care about.
• Find out more about how we’re fighting for you in Congress and across the country.
• See the latest AARP research on Medicare and more.
• AARP is your fierce defender on the issues that matter to people 50-plus. Become a member or renew your membership today. 

About 9 percent of adults 65 and older are now using GLP-1s, compared to 22 percent of adults age 50 to 64, according to a KFF poll released Nov. 14. Medicare beneficiaries who will be eligible for lower-cost GLP-1 medications include those with a body mass index (BMI) of:

• 27 or more and who have prediabetes or a history of cardiovascular disease
• Greater than 30 and who have heart failure with preserved ejection fraction — a heart that pumps normally but is too stiff to fill properly — uncontrolled high blood pressure or chronic kidney disease
• Higher than 35