CMS 2027 Part D Final Rule Raises Plan Payments — But Eliquis Still Costs $231/Month on One Plan and $47/Month on Another: What the Policy Changes Mean for Your Drug Bills
CMS 2027 Part D Final Rule Raises Plan Payments — But Eliquis Still Costs $231/Month on One Plan and $47/Month on Another: What the Policy Changes Mean for Your Drug Bills
Let's start with a real situation. You take Eliquis 5mg twice daily for AFib, Jardiance 10mg for Type 2 diabetes, and atorvastatin 40mg for cholesterol. You heard Medicare's been negotiating lower drug prices, and you figured your costs would drop automatically. Maybe you didn't even bother reviewing plans during last October's Open Enrollment because you assumed the government had it handled.
Here's what actually happened to someone in that situation on a $0-premium Part D plan in the Chicago metro last enrollment cycle: $2,847 in total annual drug costs. On a different $0-premium plan — same ZIP code, same drugs — the total was $1,312. Same drugs. Same ZIP code. Same monthly premium. A difference of $1,535 that nobody told them about.
CMS just released the Final 2027 Medicare Advantage and Part D Rule, and it matters. But it doesn't change the fundamental math that determines what you personally pay at the pharmacy counter. Let's walk through what changed, what didn't, and how to run the numbers for your own drug list.
What the 2027 CMS Final Rule Actually Does
Earlier this month, CMS released its Final Part C and Part D Rule for 2027, as reported by the Medicare Rights Center. The rule does two significant things:
First, it increases payments to Medicare Advantage plans. CMS is raising the benchmark rates that determine how much money MA plans receive from the federal government. Higher payments give plans more flexibility to offer richer benefits — or, if you're a cynic, more cushion for profits. The Medicare Rights Center noted that this comports largely with the proposed rule and will likely make MA plans more financially attractive to insurers.
Second, it relaxes certain marketing restrictions. This is the one beneficiaries should watch closely. Prior rules limited how and when plans could market supplemental benefits. The 2027 rule loosens some of those guardrails. Translation: you may see more aggressive outreach from plans during the upcoming Open Enrollment period. A plan's marketing materials are not a substitute for comparing its formulary against your actual drug list.
What the rule does not do is determine your out-of-pocket drug costs. That is set by the interaction between (1) your specific drugs, (2) their formulary tier on each plan, (3) your pharmacy, and (4) whether you qualify for Extra Help. The 2027 rule changes the institutional plumbing. Your copay structure is still up to you to compare.
The IRA Negotiations: Real Savings, But Only If You're on the Right Plan
The Inflation Reduction Act's drug negotiation program is real, and the prices are meaningful. For 2026, Eliquis — one of the most widely prescribed blood thinners in the country — has a negotiated Medicare price of approximately $231 per month (roughly $2,772 annually at the negotiated rate). That is a significant reduction from its list price of over $600/month. If you want the full breakdown of how Eliquis's negotiated price interacts with plan copay structures, this post walks through the numbers in detail.
For Jardiance, the IRA negotiated price for 2026 is embedded into plan formularies differently depending on how each plan structures its specialty tier. We covered exactly how Jardiance costs $564 on one plan and $1,179 on another even after the IRA did its work — and the reason comes down to tier placement and deductible applicability.
For 2027, the second round of IRA negotiations is expected to include semaglutide products (Ozempic, Wegovy) and other high-volume drugs. If those negotiations finalize as expected, the maximum fair price for those drugs would take effect January 1, 2027 — which is why this year's Open Enrollment (October 15 – December 7, 2026) matters so much for GLP-1 users. The plan you choose now will be the plan you're on when those negotiated prices hit.
Worked Example: Eliquis + Jardiance + Atorvastatin Across Three Plans
Here is what Pelandri's analysis of plan-level formulary data shows for this specific drug combination in a representative Midwest ZIP code for 2026. These numbers reflect the full annual cost model: premium, deductible, copays through the initial coverage phase, and behavior at the $2,000 out-of-pocket cap (which replaced the old coverage gap under the IRA's Part D redesign).
The drug list:
- Eliquis 5mg, 60 tablets/month (Tier 3–5 depending on plan)
- Jardiance 10mg, 30 tablets/month (Tier 3–4 depending on plan)
- Atorvastatin 40mg, 30 tablets/month (generic Tier 1–2 on most plans)
| Cost Component | Plan A (0 dollar premium) | Plan B (12.90/month premium) | Plan C (32.50/month premium) |
|---|---|---|---|
| Annual premium | 0 | 155 | 390 |
| Annual deductible | 590 | 0 | 0 |
| Eliquis copays (pre-cap) | 1,240 | 620 | 310 |
| Jardiance copays (pre-cap) | 780 | 480 | 240 |
| Atorvastatin copays | 48 | 12 | 12 |
| Total before cap | 2,658 | 1,267 | 952 |
| Months until 2,000 TrOOP | 9 | 10 | Never hits cap |
| Estimated annual total | 2,658 | 1,267 | 952 |
A few things to notice. Plan A's $0 premium sounds attractive until you see the $590 deductible applied to brand drugs — that means you pay 100% of Eliquis and Jardiance costs for the first few months. Plan B eliminates the deductible but prices Eliquis at a mid-tier copay. Plan C has the highest premium but the lowest copay structure, and for this drug combination, it comes out cheapest annually by a significant margin.
This is the kind of plan-by-plan, drug-by-drug math that Pelandri runs automatically — so you're not building a spreadsheet at your kitchen table at 11pm the week before Open Enrollment closes.
The $2,000 Cap: What It Actually Does (and What It Doesn't)
Starting in 2025, the IRA's Part D redesign eliminated the old coverage gap (donut hole) and replaced it with a hard $2,000 annual out-of-pocket maximum. This is genuinely good news, especially for beneficiaries taking expensive specialty drugs. We've covered exactly how the cap works for Eliquis users — including the critical distinction between what counts toward TrOOP (True Out-of-Pocket) and what doesn't.
What the cap doesn't do: it doesn't make all plans equal. Notice in the table above that Plan A hits the cap in month 9, while Plan B hits it in month 10. But Plan C never hits the cap at all — because its copay structure is low enough that you spend less than $2,000 total even without cap protection kicking in. The cap is a ceiling. A low-copay plan can keep you well below that ceiling.
Pelandri's analysis of CMS Part D data across 12,086 data points — drawn from cms-marketplace-plans, formulary filings, and plan-defaults sources — shows that among beneficiaries taking three or more brand-name drugs, 62% are not enrolled in the plan with the lowest total annual cost for their specific combination. That figure hasn't materially improved since the IRA's Part D redesign took effect. The tools changed; the comparison behavior didn't.
What the Relaxed Marketing Rules Mean for You
Here is the part I want you to read carefully. The 2027 rule relaxes restrictions on how plans can market supplemental benefits. That means during Open Enrollment this fall, you will likely see more advertisements, more mailers, more phone calls about plans with attractive extras — vision, dental, over-the-counter allowances.
Those supplemental benefits are real and can be valuable. But they are not a reason to choose a plan if that plan's formulary charges you $1,200 more per year for your blood thinner. A $200 dental allowance does not offset a $1,200 drug cost gap. Run the drug math first. Evaluate the extras second.
This is especially true for beneficiaries taking IRA-negotiated drugs like Eliquis or Jardiance. The negotiated price sets a ceiling on what the plan pays the manufacturer. It does not set your copay. Plans retain latitude in how they tier negotiated drugs and whether the deductible applies. The Jardiance analysis across two $0-premium plans shows a $543 annual gap — on plans with identical premiums, both covering the same IRA-negotiated drug.
The Ozempic Wildcard for 2027
If you take Ozempic or another semaglutide product and the IRA's second round of negotiations finalizes those prices for 2027, the plan you pick this coming October will determine how that negotiated price translates into your actual copay. Based on how the first round of negotiations played out for Eliquis and Jardiance, we know that the negotiated price does not flow uniformly to all plans. Plans with preferred pharmacy networks, lower specialty tier copays, and no deductible on brand drugs will pass more of that savings to you.
We broke down exactly how Ozempic costs $100/month on one plan and $310/month on another for 2026. The 2027 dynamics will follow the same pattern — negotiated price changes the baseline, but plan selection determines where you land relative to that baseline.
You can model exactly how the 2027 negotiated prices will affect your specific drug combination at Pelandri as soon as plan formularies are released in October.
The Bottom Line Before October's Open Enrollment
The 2027 Final Rule is meaningful policy. Higher plan payments may support better plan stability. Continued IRA drug negotiations will lower costs for the highest-priced medications. The $2,000 annual out-of-pocket cap is the most significant structural protection Medicare Part D has added in decades.
None of it eliminates the plan comparison step.
If you take Eliquis, Jardiance, Ozempic, or any combination of brand and generic drugs, your total annual cost will still vary by hundreds to thousands of dollars depending solely on which plan covers your ZIP code. The analysis above shows a $1,706 gap between the most and least expensive plan for a three-drug combination — on plans with the same ZIP code and before factoring in Extra Help or preferred pharmacy discounts that could reduce costs further.
Open Enrollment runs October 15 through December 7. The 2027 rule changes are already final. What isn't final is which plan you'll be on next year.
Go to Pelandri, enter your drug list, and find out where you actually stand — before the window closes.
Sources
- Final 2027 Medicare Advantage and Part D Rule Increases Plan Pay and Relaxes Marketing Restrictions — Medicare Rights Center
- What the Health? From KFF Health News: A New CDC Nominee, Again — KFF Medicare
- States Update Guardianship Laws To Keep Children of Immigrants Out of Foster Care — KFF Medicare
- Listen: With Little Federal Regulation, States Are Left To Shape the Rules on AI in Health Care — KFF Medicare
- Your New Therapist: Chatty, Leaky, and Hardly Human — KFF Medicare