Sweeping changes over the past few years to Medicare Part D will continue in 2026, with insurers recalibrating offerings to align with new federal mandates and evolving member expectations. Steering the ship for Humana is TJ Gibb, President of Medicare Part D. Speaking to Insurance Business (IB), he explained the most significant changes coming down the line include contraction of the number of carriers, federal drug price negotiations and member cost-sharing caps.
“Some of the regulatory requirements are pretty routine,” Gibb told IB, referencing the Inflation Reduction Act (IRA) mandates. “There’s a maximum out-of-pocket that’s already in place – $2,000 is increasing to a limit of $2,100. Your maximum Medicare deductible will go from $590 a year to $615.”
2026 also marks the first year in which the federal government will enforce price negotiations for selected high-cost drugs – a milestone development under the IRA.
One of the most impactful shifts in the Part D program was the introduction of an annual maximum out-of-pocket cap, or MOOP. A change that may shape member plan purchasing behavior.
“Member annual prescription drug costs are more predictable now. Your monthly premium plus estimated cost sharing out of pocket costs allows members to more accurately budget their expenses.
“However, everyone has unique circumstances that will influence the best plan for them. The lowest premium is not always the best plan for your situation. Everybody’s different. Every situation is different. It’s not a one-size-fits-all.”
As part of this outreach and transparency push, Humana and other carriers will distribute key documents typically in September – including the Annual Notice of Change and updated Prescription Drug Guides.
“Candidly, a lot of people ignore those. They’re lengthy, comprehensive documents, but strongly encourage people to review them to see what has changed in their plan. Maybe their drugs have been removed from formulary, or they have shifted on the cost sharing tier impacting your pocketbook.” If you have an insurance broker, contact them to assist in the review process and potential selection of a new plan.
This article was created by Insurance Business Magazine in partnership with Humana Read full article