Medicare in Wyoming Series: 2026 Part D Changes

As we approach 2026, significant changes are coming to Medicare Part D that may affect Medicare in Wyoming, especially those preparing for or currently enrolled in the program. Understanding these changes is crucial for making informed decisions about healthcare in the coming years. This blog post breaks down the important elements of Medicare Part D changes, including phases of coverage, the new Medicare Drug Price Negotiation Program, and updates to Creditable Coverage.

What is Medicare Part D?

Medicare Part D is a program that provides prescription drug coverage to Medicare beneficiaries. Part D helps cover the costs of medications, which can be a significant financial burden for many seniors. The program is available through private insurance companies that are approved by Medicare. Beneficiaries can choose different plans based on their healthcare needs and budget.

In Wyoming, this program plays a vital role in accessing necessary medications. With the impending changes in 2026, it is essential for beneficiaries to understand how their coverage may be impacted.

Medicine as a vital part of healthcare for Medicare beneficiaries.

The Phases of Part D Coverage

The new Part D has three phases:

1. Phase I: The Deductible Phase

2. Phase II: Initial Coverage

3. Phase III: Catastrophic Coverage

   
   

Phase I: The Deductible Phase

In 2026, your client starts by paying the full cost of medications until the $615 deductible is met. This remains unchanged, although the deductible amount has slightly increased from previous years.

Phase II: Initial Coverage

Once the deductible is satisfied, your client moves into the revamped Initial Coverage phase.

During this phase, they pay 25% of the costs while various parties handle the remaining 75%:

• The plan sponsor usually covers 65% for applicable and selected drugs (75% for other covered medications)

• Drug manufacturers provide a 10% contribution for applicable drugs through the Manufacturer Discount Program

• CMS offers a new 10% subsidy for selected drugs during applicable pricing periods

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Phase III: Catastrophic Coverage

Once clients reach the $2,100 out-of-pocket limit in 2026 (a slight increase from $2,000 in 2025), they will continue to pay $0 for covered prescriptions for the rest of the year.

Behind the scenes, cost-sharing continues with sponsors covering 60%, manufacturers contributing 20% for applicable drugs, and CMS covering 20-40% depending on the medication type.

Medications available for Medicare beneficiaries.

Initial Phase of Medicare Drug Price Negotiation Program Begins

One of the most significant changes coming in 2026 is the implementation of the Medicare Drug Price Negotiation Program. This initiative allows Medicare to negotiate prices for certain high-cost drugs, a change that aims to make medications more affordable for beneficiaries.

In the first wave, negotiations will focus on 10 specific high-cost medications. For some essential treatments, this means lower prices for beneficiaries, allowing more manageable out-of-pocket costs. The negotiations will include commonly used medication classes like insulin and certain cancer treatments, impacting many in Wyoming.

1. Eliquis (apixaban) - Used to prevent blood clots and stroke

2. Jardiance (empagliflozin) - For type 2 diabetes and heart failure

3. Xarelto (rivaroxaban) - Blood thinner

4. Januvia (sitagliptin) - For type 2 diabetes

5. Farxiga (dapagliflozin) - For diabetes, heart failure, and kidney disease

6. Entresto (sacubitril/valsartan) - For heart failure

7. Enbrel (etanercept) - For rheumatoid arthritis and psoriasis

8. Imbruvica (ibrutinib) - For certain blood cancers

9. Stelara (ustekinumab) - For psoriasis, psoriatic arthritis, and inflammatory bowel diseases

10. NovoLog/Fiasp (insulin aspart) - Insulin products

Beneficiaries should stay informed about the drugs selected for negotiation and their potential savings. This program is part of a broader effort to contain drug pricing, particularly for the elderly population, who often rely heavily on medications for managing chronic conditions.

Pharmacist ensuring the right medications are provided for beneficiaries.

Creditable Coverage

Creditable coverage is an essential aspect of Medicare Part D that affects those with existing prescription drug plans. When a prescription drug plan is considered “creditable,” it means that the coverage is at least as good as standard Medicare Part D. This status has implications for beneficiaries when they transition to Medicare.

In 2026, there will be updates to how carriers provide notifications about creditable coverage. It's crucial for Wyoming residents who maintain other health plans (like employer-sponsored plans) to understand their status regarding creditable coverage to avoid late enrollment penalties when they enroll in Medicare.

Beneficiaries need to keep records of their creditable coverage notifications to ensure they aren't penalized for any gaps in coverage should they choose to enroll in Medicare Part D later. Regular communication with your healthcare provider and plan administrator will ensure you have the latest information on your coverage status.

How Will These Changes Impact Wyoming Residents?

For Wyoming residents approaching Medicare eligibility or currently enrolled, the changes to Medicare Part D in 2026 can have a substantial impact. Here’s what you should keep in mind:

• Lower Medication Costs: With the Drug Price Negotiation Program, residents can expect lower prices for high-cost medications, which can significantly reduce the financial burden.

• Easier Navigation Through Coverage Phases: The upcoming changes to the coverage gap will help more beneficiaries avoid exorbitant costs during the donut hole phase, making it easier to manage medications budget-wise.

  
  

• Importance of Creditable Coverage: If you have other insurance that offers drug coverage, understanding whether your plan is creditable is critical. Keeping track of this information can prevent unnecessary penalties.

  
  

To maximize your benefits and understand the implications of these changes, you can reach out to your local agent. Golden Meadowlark Insurance is located in Sheridan, Wyoming and we are here to help. We can be reached at 307-461-5555.

Brochures provide essential information about Medicare changes.

Remember, knowledge is power. Stay informed, and you'll be better equipped to tackle your Medicare needs!

Check out another blog about Part D in our Medicare in Wyoming Series:

Medicare Part D Basics for Seniors New to Medicare