How Changes in Drug Price Policy Affect Your Wallet and Part D Plan

Medicare prescription drug coverage has changed significantly over the past several years, and more updates are coming in 2027. For people enrolled in Original Medicare who already have a stand-alone Part D prescription drug plan (PDP), or those considering one, these changes could be important for both your health and finances.

Understanding these changes and carefully evaluating plan options during Medicare’s Annual Enrollment Period (October 15 to December 7) can help you make smarter decisions about your prescription coverage that may better protect your health and save you money throughout the year.

More Medications at Negotiated Prices

One of the most significant changes is the expansion of Medicare's Drug Price Negotiation Program, under the Inflation Reduction Act, which gives Medicare the ability to negotiate prices for certain high-cost drugs. Beginning in 2027, 15 additional high-cost medications will be available at reduced prices, joining the first 10 drugs that became eligible this year.

The 2027 list includes popular GLP-1 medications such as Ozempic and Wegovy for the treatment of conditions including diabetes, cardiovascular disease and sleep apnea.

All Part D plans must cover these negotiated-price medications, and according to the Centers for Medicare & Medicaid Services (CMS), the lower prices could save people enrolled in Medicare prescription drug coverage under the defined standard benefit design an estimated $685 million.

A Cap on Out-of-Pocket Costs

The Inflation Reduction Act also continues to provide important financial protection by limiting annual out-of-pocket prescription drug spending.

In 2027, the annual out-of-pocket maximum for covered prescriptions is expected to be $2,400, including your deductible. Once you reach that limit, you'll pay nothing for covered medications for the remainder of the year.

However, your individual out-of-pocket costs, which include deductibles, copayments and/or coinsurance, will vary depending on the plan you select.

New Program for Weight-Loss Medications

Medicare has a new program called the Medicare GLP-1 Bridge pilot program to help pay for certain GLP-1 weight loss medicines.

For the first time, eligible Medicare beneficiaries will have access to certain GLP-1 medications for obesity treatment under this pilot program, which is scheduled to run through the end of 2027. Eligible participants may obtain Foundayo (orforglipron), Wegovy (semaglutide), and Zepbound (tirzepatide) KwikPen for $50 per month.

It's important to understand, however, that the Medicare GLP-1 Bridge program operates separately from Part D coverage. The $50 payment does not count toward your Part D deductible or annual out-of-pocket maximum.

If you're currently taking a GLP-1 medication that isn't included in either the Medicare GLP-1 Bridge program or Medicare's negotiated-price list, talk with your physician about whether switching to a covered medication is appropriate for your medical needs, since it may substantially reduce your costs.

Direct-to-Patient Programs Are Not Prescription Drug Plans

Over the past year, a growing number of direct-to-patient (DTP) prescription drug programs have emerged, often offering substantial discounts on individual medications.

These programs may provide meaningful savings on specific drugs, but they are not a substitute for creditable prescription drug coverage. Relying solely on one of these programs could leave you responsible for the full cost of expensive medications if you develop an unexpected health condition requiring a high-cost drug treatment that’s not part of your DTP program. In addition, purchases made through these programs will not count toward your Part D deductible or annual out-of-pocket maximum, if used as a supplement to your drug plan.

Additionally, these programs are not considered creditable prescription drug coverage. If you delay enrolling in Part D because you're relying on DTP programs for your medication needs, you could face permanent late-enrollment penalties.

Choosing the Right Plan for 2027

As Part D continues to evolve, comparing plans is becoming more important than ever.

Starting to research your options early is highly recommended, since it can take time to navigate the process. Medicare.gov offers useful comparison tools, and a licensed Humana Medicare sales agent can also help you evaluate plans based on your individual needs.

When comparing plans, these are some important questions to ask your sales agent:

• Does the formulary include medications I need now and in the months ahead? Consider not only your current prescription drugs but also your potential future medication needs. While there’s no way to predict every medical event, ask your physician if any of your current health issues may require drug treatments in the coming year.
• What are the total costs of the plan? Focusing just on the premium can lead you astray. Deductibles, co-payments/co-insurance, medication tiering and pharmacy network pricing could have a greater impact on overall spending. Make sure to take those into account when assessing your overall plan costs.
• Is my pharmacy in the plan’s preferred cost-sharing pharmacy network? Plan networks may include preferred cost-sharing pharmacies that often offer lower out-of-pocket costs than standard cost-sharing network pharmacies. Verify whether the pharmacy you regularly use is in the plan’s cost-sharing pharmacy network, or decide whether you’re willing to switch to one that is.
• Does the plan include a home-delivery pharmacy option? Home-delivery pharmacies may save you money, and there’s also the convenience factor that you may value.

The Bottom Line

Recent policy changes are impacting prescription drug affordability for many Medicare beneficiaries. If you’re eligible for Medicare, choosing the right Part D plan remains one of the best ways to safeguard your health and your finances. Take the time to research and choose a plan that offers the best overall value by balancing affordability, access to your medications and the protection it will provide should your health needs change.

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