Question: I paid so much for my Eliquis this year, will I have to pay that much next year too?

Answer: The good news is no, seniors will not pay as much for Eliquis as well as nine other common medications in 2026. Remember that Centers for Medicare Services (CMS) announced that in 2026 there will be TEN medications that are now at a negotiated price. These ten medications are all brand name medications.

The list includes: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbrucia, Stelara, and Fiasp and Novolog Insulins.

This list is going to have a positive impact on many senior households. Now I will give you some examples with approximate pricing. In 2025 your Eliquis retails for $590 and once you have met your deductible, you likely paid a 25% cost share at the pharmacy which was $123. In 2026 that same Eliquis has a negotiated price of approximately $260 and therefore your 25% cost share is $65. Now, it will take longer to get through your $615 deductible, but you will be spending significantly LESS in 2026. Let’s review some others, Farxiga in 2025 retails for $555 and your 25% would be $139. In 2026, your Farxiga has a negotiated price of approximately $195 and therefore your 25% cost share is $49. Jardiance in 2025 retails for $580 and your 25% cost share would be $145. In 2026, Jardiance has a negotiated price of approximately $215 and therefore your cost share would be $54. Xarelto in 2025 retails for $580 And your 25% would be $145. In 2026, Xarelto has negotiated a price of approximately $217 and therefore your 25% would be $55.

You can see with just these four examples of the ten medications in this program, that those buying these medications will save significantly in 2026. Now in 2025 if you were taking one or more of these medications, you likely met the maximum out of pocket (MOOP) in 2025 of $2000. When this happens you have moved into the catastrophic phase of Part D coverage and ALL your medications are reduced to $0 copay for the remainder of the year. In 2026 that MOOP goes up to $2100 to reach the catastrophic phase of Part D coverage. For many taking one or more of the price controlled medications, they will likely NOT reach that MOOP level because they are not paying as much at the pharmacy as they have in years past.

That is good news for many seniors. The other good news is that in 2027 there will be additional medications added to the price controlled list for those on Medicare.

Another piece of good news is that some of these medications are beginning to be offered in generic form. Xarelto has a generic equivalent called rivaroxaban. Farxiga has a generic equivalent called dapagliflozin. Stelara has a generic equivalent called Ustekinumab. Fiasp and Novolog have a generic equivalent called insulin aspart, human. That means in coming years we will see significant cost savings on the generic equivalent for sure and likely the brand name price will drop as well. The first year a medication is offered generically, we usually see our Part D plans not cover the generic equivalent as it is too new and was not added to their formulary, so it usually takes a couple of years before we see significant price drops in these situations.

Before you request the generic alternatives be sure that your Part D plan is covering the generic. That rule sometimes changes mid-year, so what you weren’t allowed to get in January as a generic substitute, you may be able to get later in the year. You can work with your physician as your situation changes.

I am excited as we have seen significant cost savings for all individuals on Medicare Part D in the last couple of years, at least at the pharmacy. But this means the insurance companies are having to pay MORE of your medication costs and therefore tend to increase the premiums that you pay for the insurance coverage. But overall I believe it is a significant savings and should be celebrated.

Happy Insurance Season! Be sure to evaluate your coverage for the new year and hopefully you will see reduced overall costs on your medications.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.