Lower Prices for Eliquis and Jardiance in Part D (2026-2027)

If you take prescription blood thinners or diabetes medications, you know how quickly pharmacy bills can drain your retirement budget. For years, Medicare beneficiaries have paid steep prices for brand-name maintenance medications. But starting in 2026, a massive shift in how Medicare pays for drugs takes effect, bringing significantly lower prices for Eliquis and Jardiance in Medicare Part D.

Millions of Americans rely on these two specific medications. Because they do not currently have cheaper generic equivalents available in the United States, patients have been stuck paying high deductibles and coinsurance percentages based on list prices that exceed $500 a month. The new Medicare drug price negotiations change that math entirely.

However, the way these discounts actually reach your wallet is complex. The headline-grabbing discounts of 56% to 66% do not mean your pharmacy copay will automatically drop by that exact percentage. To understand what you will actually pay at the pharmacy counter in 2026 and 2027, you have to understand how negotiated prices interact with your plan's deductible, your coinsurance rates, and the new annual out-of-pocket spending caps.

The Medicare Drug Price Negotiation Program Explained

Historically, federal law strictly prohibited Medicare from negotiating bulk discounts directly with pharmaceutical manufacturers. Instead, the private insurance companies that manage Medicare Part D plans had to negotiate their own rebates behind closed doors. This often left consumers paying out-of-pocket costs based on artificially inflated retail list prices.

The Inflation Reduction Act (IRA) changed this rule. For the first time, the Centers for Medicare & Medicaid Services (CMS) was given the authority to negotiate the prices of the most expensive and widely used drugs covered under Medicare Part D. The process targets medications that have been on the market for several years without generic competition.

The first round of negotiations focused on 10 specific drugs, and the new prices officially take effect on January 1, 2026. These negotiated rates are called the "Maximum Fair Price" (MFP). By law, no Medicare Part D plan can pay the manufacturer more than the MFP for these specific drugs.

While the program includes 10 drugs, the impact is heavily concentrated. Drugs like Xarelto and Januvia are on the list, but Eliquis and Jardiance represent a massive portion of Medicare's annual pharmacy spending. Because Medicare Part D costs are community-rated—meaning premiums and deductibles do not vary by age—these savings impact the entire Medicare risk pool, stabilizing costs for everyone, even those who do not take these specific medications.

First Round Drugs: Eliquis and Jardiance Take Center Stage

Eliquis (manufactured by Bristol Myers Squibb) is a widely prescribed blood thinner used to prevent blood clots and stroke, particularly in patients with atrial fibrillation. Jardiance (manufactured by Boehringer Ingelheim) is a medication used to lower blood sugar in adults with type 2 diabetes and to reduce the risk of cardiovascular death and heart failure.

Because these conditions are highly prevalent among adults aged 65 and older, these two drugs are staples in the Medicare Part D system. Before the negotiations, the list prices for these drugs drove many seniors deep into the catastrophic coverage phases of their plans.

Here is a look at the official price changes taking effect in 2026:

At first glance, a 56% discount on Eliquis and a 66% discount on Jardiance look like massive, immediate savings. And they are—but it is critical to understand exactly who is getting that discount first. The negotiated price is the baseline from which your insurance company calculates your share of the cost.

The Difference Between Maximum Fair Price and Your Copay

One of the most common misunderstandings about the new Medicare drug prices is the belief that the Maximum Fair Price is the flat copay you will pay at the pharmacy. If you walk into a pharmacy in 2026 expecting to pay exactly $231 for a month of Eliquis, you are misunderstanding how Part D insurance works.

The $231 figure for Eliquis and the $197 figure for Jardiance represent the maximum amount your Medicare Part D plan will pay the drug manufacturer. Your actual out-of-pocket cost is a percentage or a flat fee based on that negotiated price, depending on which phase of Part D coverage you are currently in.

How Coinsurance Works with the New Prices

Many Medicare Part D plans use "coinsurance" for expensive brand-name drugs, rather than a flat copay. Coinsurance means you pay a percentage of the drug's total cost. A very common coinsurance rate for preferred brand-name drugs in the initial coverage phase is 25%.

Let's look at how the negotiated price changes your out-of-pocket math if your plan charges 25% coinsurance:

• Before Negotiation (Based on 2023 List Price): If Eliquis cost $521, your 25% coinsurance would be roughly $130.25 per month.
• After Negotiation (Based on 2026 Price): With the new price of $231, your 25% coinsurance drops to roughly $57.75 per month.

In this scenario, the negotiated price saves you about $72.50 every single month at the pharmacy counter. Over a year, that is a savings of $870 just on one medication. The discount flows through the system to lower your coinsurance burden.

How Negotiated Drug Prices Affect Member Out-of-Pocket Costs

To fully grasp what you will pay for Eliquis and Jardiance in 2026 and 2027, you have to map those negotiated prices against the standard phases of Medicare Part D. Your costs change depending on how much you have spent throughout the calendar year.

Phase 1: The Annual Deductible

Before your plan starts sharing the cost of your medications, you must meet your annual deductible. In 2026, the maximum allowable standard deductible for a Part D plan is $615. In 2027, this maximum allowable standard deductible increases to $700. Understanding the Medicare Part D deductible is the first step in calculating your early-year costs.

If your plan applies the deductible to all drug tiers (which is common for standalone Part D plans), you will pay the full negotiated price of the drug until the deductible is met.

For example, in January 2026, if you need a refill of Eliquis, you will pay the full negotiated price of $231 out-of-pocket. In February, you will pay another $231. In March, you will pay $153 to finish meeting your $615 deductible, and then your plan's coinsurance or copay will kick in for the remainder of that month's fill.

Phase 2: The Initial Coverage Phase

Once your deductible is met, you enter the initial coverage phase. This is where you pay either a flat copay (e.g., $45) or a coinsurance percentage (e.g., 25%) for your drugs. Because the baseline cost of Eliquis and Jardiance is now much lower, your coinsurance will be calculated against the $231 or $197 figures, respectively, keeping your monthly costs manageable.

Phase 3: The Catastrophic Phase (The Annual Cap)

The most significant protection for Medicare beneficiaries is the hard cap on annual out-of-pocket spending. In 2026, out-of-pocket costs for covered Part D drugs are capped at $2,100. In 2027, this out-of-pocket cap will increase to $2,400.

Once you spend $2,100 out of your own pocket in 2026 (including your deductible and copays), you reach the catastrophic phase. At this point, you pay $0 for all covered Part D drugs for the rest of the calendar year.

Scenario: Taking Both Eliquis and Jardiance

It is incredibly common for Medicare beneficiaries to take both a blood thinner and a diabetes medication. If you take both Eliquis and Jardiance, the new negotiated prices and the annual spending caps work together to protect your finances.

Let's walk through a realistic scenario for a beneficiary in 2026 who takes both drugs, assuming a plan with a $615 deductible and a 25% coinsurance rate thereafter.

In this scenario, taking both Eliquis and Jardiance costs the beneficiary $1,745.25 for the entire year of 2026. Because this is below the $2,100 annual out-of-pocket cap, they will not hit the catastrophic phase based on these two drugs alone. However, if they take other brand-name medications, they will likely hit the $2,100 cap by late summer, after which all their covered drugs would be completely free.

The End of the Donut Hole and How It Helps You

If you have been on Medicare for a few years, you likely remember the dreaded "donut hole" or coverage gap. In the past, after you and your plan spent a certain amount on drugs, you entered a gap where you were suddenly responsible for 25% of the list price of your medications until you hit catastrophic coverage.

Because the list prices of Eliquis and Jardiance were so high (over $500 each), taking just one of these drugs would almost guarantee you would fall into the donut hole by mid-year, causing a sudden spike in your monthly pharmacy bills.

As of 2025, the coverage gap was eliminated. Moving into 2026 and 2027, the Part D benefit consists of only three simple phases: the deductible, the initial coverage phase, and the catastrophic phase. Does the Medicare Part D donut hole still exist? No. You no longer have to worry about a sudden mid-year price spike for your maintenance medications.

Managing Costs with the Medicare Prescription Payment Plan (M3P)

Even with lower negotiated prices and a $2,100 cap in 2026, coming up with $400 to $600 at the pharmacy counter in January and February to meet your deductible can be a massive financial strain. Medicare recognized this cash flow problem and introduced a solution.

The Medicare Prescription Payment Plan (M3P) is a new, opt-in program that launched in 2026. It allows beneficiaries to smooth out their out-of-pocket drug costs into monthly installments over the calendar year, rather than paying large lump sums at the pharmacy counter.

If you opt into this program, you do not pay the pharmacy when you pick up your Eliquis or Jardiance. Instead, your Part D plan pays the pharmacy, and the plan sends you a monthly bill. The bill takes your total projected out-of-pocket costs for the year and divides it across the remaining months.

For example, if you are projected to hit the $2,100 cap in 2026, the M3P program allows you to pay roughly $175 a month to your insurance company, rather than paying $615 in January to clear your deductible. There are no fees or interest charged to use this program, but you must proactively contact your Part D plan to opt in.

Why You Cannot Use Manufacturer Coupons on Medicare

When seniors see the high list prices of Eliquis and Jardiance, they often look for ways around the insurance system. You have likely seen television commercials or online ads for manufacturer savings cards that promise to lower your copay to "$0 to $10 a month."

It is vital to understand a strict legal reality: using commercial manufacturer copay cards is illegal for Medicare beneficiaries. These cards are funded by pharmaceutical companies to bypass insurance formularies, which violates the federal Anti-Kickback Statute when applied to government-funded healthcare programs like Medicare.

If you try to hand a manufacturer coupon to your pharmacist along with your red, white, and blue Medicare card, the pharmacy system will reject it. You must rely on your Part D plan's negotiated rates and the annual out-of-pocket caps. If you have limited income and resources, you should instead apply for the federal Extra Help program, which subsidizes Part D premiums, deductibles, and copays legally.

Why Standalone Part D Premiums Are Changing in 2027

While the negotiated drug prices and out-of-pocket caps are excellent news for consumers at the pharmacy counter, they put immense financial pressure on the insurance companies that manage Part D plans. Because insurance carriers now have to cover 100% of drug costs after a member hits the $2,100 (2026) or $2,400 (2027) cap, they are looking for ways to balance their budgets.

To prevent massive premium spikes when these rules were first announced, the government implemented a temporary premium stabilization demonstration. This program capped how much Part D premiums could increase year over year. However, this premium stabilization demonstration ends after 2026.

Because the stabilization ends, standalone Part D premiums are expected to rise and show more volatility in 2027.

For context on the baseline costs:

• 2026: The national base beneficiary premium is $38.99.
• 2027: The national base beneficiary premium increases to $41.33.

CMS projects the average standalone prescription drug plan (PDP) premium will be around $36 in 2027, but this is just an average. Some plans with robust formularies may charge significantly more. Insurance carriers may also change their formularies, moving certain drugs to higher tiers to offset the costs of the new out-of-pocket caps.

The Impact on Late Enrollment Penalties

The rising base premium also affects the Medicare Part D late enrollment penalty. If you delayed enrolling in Part D without having creditable coverage (like employer insurance), Medicare assesses a lifetime penalty.

The penalty is calculated as 1% of the national base beneficiary premium for every full month you went without coverage.

Because the base premium is rising, your penalty amount will increase slightly. For 2026, the penalty multiplier is roughly $0.39 per month ($38.99 x 1%). For 2027, it will be roughly $0.41 per month ($41.33 x 1%). If you were uninsured for 24 months, you will pay an extra $9.84 every month in 2027 on top of your standard premium.

What to Check on Your 2026 and 2027 Plan Formulary

Because insurance companies are adjusting to the new $2,400 cap in 2027 and the end of premium stabilization, you cannot assume that the plan that covered your Eliquis and Jardiance well in 2026 will be the best plan for you in 2027.

The Annual Enrollment Period (AEP) runs from October 15 to December 7, 2026, for coverage taking effect January 1, 2027. If you miss this window, you are generally locked into your plan for the entire year. Missing the December 7 Medicare deadline can be an expensive mistake.

During the AEP, you must review your plan's formulary (the official list of covered drugs). Here is a short checklist of exactly what to look for regarding Eliquis and Jardiance:

• Tier Placement: Are Eliquis and Jardiance on Tier 3 (Preferred Brand) or Tier 4 (Non-Preferred Brand)? Moving a drug to a higher tier increases your coinsurance percentage.
• Deductible Application: Does the 2027 maximum allowable deductible of $700 apply to the tier your drugs are on? Some plans waive the deductible for Tier 1 and Tier 2, but apply it to Tier 3.
• Prior Authorization: Has your plan added a rule requiring your doctor to submit paperwork proving you need Jardiance before they will pay for it?
• Step Therapy: Does the plan require you to try a cheaper, alternative medication before they will approve Eliquis? (This is less common for these specific drugs due to a lack of exact alternatives, but it is a tactic carriers use to control costs).
• Quantity Limits: Will the plan only cover a 30-day supply at a time, or can you get a 90-day supply through mail-order for a lower overall copay?

How to Compare Medicare Part D Rates on Rebel Rates

The introduction of negotiated prices for Eliquis and Jardiance, combined with the new $2,400 out-of-pocket cap for 2027, makes this the most critical enrollment season in recent history. You cannot control the Maximum Fair Price negotiated by the government, but you can control which insurance company you pay your monthly premium to.

Because premiums and formularies are shifting rapidly as carriers adjust to the end of the stabilization program, comparing your options is non-negotiable. Do not let brand loyalty to an insurance company cost you hundreds of dollars at the pharmacy counter.

At Rebel Rates, we believe in giving you the numbers without the sales pitch. You can compare Medicare quotes side-by-side to see exactly which Part D plan offers the lowest total out-of-pocket cost for your specific combination of medications. Enter your zip code, input Eliquis and Jardiance, and let the math show you the lowest rates for 2027.