2026 Medicare Part D Changes: FAQ – Specialty Pharmacy

Changes to Medicare Part D take effect in January 2026.

These changes may impact your specialty pharmacy coverage, out-of-pocket costs, and prescriptions. PromptCare is here to help patients understand what these updates mean for your treatment and benefits. Read our FAQ to learn how to get the most value and support from your Part D benefits.

What are the key changes to Medicare Part D in 2026?

• Annual spending limit: Effective January 1, 2026, the total out-of-pocket amount patients will pay for Part D-covered prescription drugs is capped at $2,100 annually.
• Deductible: Effective January 1, 2026, the new Part D prescription drug deductible is $615.

How will these changes impact Medicare Part D costs?

• Lower out-of-pocket costs: The annual spending limit and flexible payment plans are designed to reduce your overall drug costs and financial burden.

What can you do to prepare for these changes?

• Review your plan: Evaluate your current Medicare Part D plan to ensure it meets your needs. Be sure to consider factors like specific medications, pharmacy network, and copayments.
• Contact your insurance company: If you are interested in a Medicare Prescription Payment Plan, you must opt in to the program. Visit your plan’s website and complete a Medicare Prescription Payment Plan Participation Request Form. If you have questions or require further guidance, call the phone number on the back of your insurance card.
• Where can you get more information?
• Medicare’s official website: Visit medicare.gov for the latest information on Part D changes and other Medicare benefits.
• State Health Insurance Assistance Program (SHIP): SHIP counselors can provide free, unbiased advice on Medicare and other health insurance options.

Learn More

If you have any questions about changes to your Medicare Part D coverage, please contact us for more information.

866-776-6782