Medicare Drug Coverage Is Changing—Here’s What You Need to Know This Enrollment Season

If you or a loved one relies on prescription medications, the 2026 Medicare Open Enrollment period (Oct. 15–Dec. 7, 2025) brings major updates that could impact your coverage, costs, and choices. From new caps to evolving formularies, here’s how to stay ahead of the curve.

Medicare Part D Redesign: What’s New in 2026

Thanks to the Inflation Reduction Act, Medicare Part D continues its transformation in 2026:

• Annual out-of-pocket costs are capped at $2,100, up slightly from $2,000 in 2025.
• Insulin remains capped at $35/month, regardless of plan.
• Low-income subsidies (Extra Help) have expanded, making more beneficiaries eligible for reduced premiums and copays.

These changes offer critical relief for seniors managing chronic conditions like cancer, diabetes, and heart disease—and simplify budgeting for high-cost medications.

GLP-1 Drugs: Coverage Still Varies

Drugs like Ozempic, Wegovy, and Zepbound—originally approved for diabetes—are now widely prescribed for weight loss. But coverage remains uneven:

• Some Medicare Advantage and employer plans cover them for obesity, especially with supporting diagnoses.
• Others restrict access due to cost or lack of FDA approval for weight loss alone.
• CVS Caremark recently dropped Zepbound from its formulary, sparking backlash.

If you’re prescribed a GLP-1 drug, check your plan’s formulary and talk to your agent about prior authorization, appeals, or alternative coverage options.

TrumpRx Portal Debuts in 2026

Launching in early 2026, TrumpRx is a new federal website designed to:

• Redirect consumers to manufacturer platforms offering discounted direct-to-consumer pricing.
• Increase transparency and competition in drug pricing.

While not a pharmacy, TrumpRx could be a valuable tool for uninsured or underinsured consumers seeking affordable access to brand-name medications.

Premiums Drop, Choices Expand

CMS reports that Medicare Advantage and Part D premiums declined in 2025, and 2026 brings:

• More plan choices
• Ask about HSA-qualified plans and telehealth options Stronger consumer protections
• Greater flexibility—but also more complexity

Your agent can help you compare options and avoid costly surprises.

What You Can Do Right Now

WCMS reports that Medicare Advantage and Part D premiums declined in 2025, and 2026 brings:

• Review your current plan: Confirm your medications are covered and that you’ll benefit from the new $2,100 cap.
• Ask about GLP-1 coverage: Your agent can help navigate prior authorizations or find alternative plans.
• Explore manufacturer discounts: Many offer coupons or patient assistance programs for specialty drugs.
• Bookmark TrumpRx: Stay informed as the portal rolls out in 2026.
• Talk to your agent: They’re your best resource for understanding coverage changes and finding savings.

Prescription drug coverage is no longer one-size-fits-all. With new rules, new tools, and new medications entering the market, staying informed is essential. Your agent can help you make sense of it all—and ensure you’re getting the coverage you deserve.

In this issue:

This Just In ... Medicare Part D Out-of-Pocket Cap Increases to $2,100 in 2026

Medicare Drug Coverage Is Changing—Here’s What You Need to Know This Enrollment Season

Aging Alone: Why Long-Term Care Planning Matters More Than Ever

Never Outlive Your Savings: How Longevity Annuities Can Help

Traveling Abroad with Medicare: What You Need to Know

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