Eliquis and Farxiga Cost $1,697 a Year on a $0-Premium Part D Plan vs. $1,620 on a $41/Month Plan: What to Compare Before December 7
You take Eliquis, Farxiga, metoprolol succinate, and atorvastatin. You've been on the same Part D plan for three years. It has a $0 premium, so it feels like the safe choice.
Here is the question this post answers: what does that four-drug list cost you over a full year on a $0-premium plan, compared with a plan that charges $41 a month?
In the worked example below, the "cheap" plan costs $1,697 a year. The plan with a premium costs $1,620. The gap is small, and it can flip in either direction depending on your drug list. That is the reason to run the numbers before Open Enrollment closes December 7.
Why your drug list decides the plan
A KFF poll summarized this month by the Medicare Rights Center looked at adults with multiple or complex health conditions, including older Medicare beneficiaries. It found real access and affordability problems in that group. The pattern makes sense. Each additional chronic condition adds a drug, and each drug is priced by its own formulary tier, deductible treatment, and pharmacy network.
A plan that looks cheap for one person's list can be expensive for another's. Plan premiums tell you almost nothing about that.
For comparison, KFF Health News reported this month on healthcare workers in Idaho who dropped ACA marketplace coverage after premiums rose by hundreds of dollars a month. That is the marketplace, a different system. In Part D, going without coverage has its own cost: a late enrollment penalty of 1% of the national base premium for every uncovered month, added to your premium for as long as you have Part D. The 2026 base premium was $38.99, so each month without coverage adds about 39 cents to your premium for life. A gap of a few years adds up.
The lesson for Part D is to compare before you drop coverage or default to last year's plan.
A note on the data behind this post
Pelandri's data layer holds 12,086 rows across six sources:
- cms-marketplace-plans: 4,080 rows
- plan-defaults: 30 rows
- bls-medical-cpi: 1,080 rows
- aca-subsidy-params: 210 rows
- employer-plan-data: 400 rows
- census-acs-health-coverage: 6,286 rows
Most of these describe ACA marketplace and employer coverage, not Part D formularies. I'm not going to pretend they price your Eliquis. Part D pricing comes from each plan's own formulary and Medicare Plan Finder.
What those files do show is structural. Across our cms-marketplace-plans and plan-defaults data, deductible, copay, and coinsurance design varies widely between plans with similar premiums. Part D works the same way, so the premium is the least informative number on the page.
The dollar figures below are illustrative plan designs built on real 2026 Part D parameters. They are not quotes from any specific plan. Your plans in your ZIP code will differ.
The worked example: four drugs, two plans
The drug list (30-day supply each):
| Drug | Monthly price used | Notes |
|---|---|---|
| Eliquis 5 mg, twice daily | $231 | Medicare-negotiated price for 2026 |
| Farxiga 10 mg, once daily | $178.50 | Medicare-negotiated price for 2026 |
| Metoprolol succinate 50 mg | $8 | Generic |
| Atorvastatin 40 mg | $6 | Generic |
| Total | $423.50/month, or $5,082/year |
The negotiated prices for Eliquis and Farxiga are covered in our post on Eliquis at $231/month and Farxiga at $178.50/month.
The 2026 Part D rules used here:
- The standard deductible is capped at $615.
- Annual out-of-pocket spending is capped at $2,100.
- There is no separate "donut hole" anymore.
CMS indexes these numbers each year, so check the 2027 figures in Plan Finder. See our explainer on the coverage gap that disappeared in 2026 for how that changed things.
Plan A: $0 premium, full deductible
- Premium: $0
- Deductible: $615, applied to every drug, generics included
- After the deductible: 25% coinsurance on preferred-brand drugs (Eliquis and Farxiga), and $0 for generics
Month 1: You pay the full $423.50, which is all deductible.
Month 2: You pay the remaining $191.50 of deductible. Then coinsurance applies to the rest of that month's brand spending, about $58.
- Month 2 total: about $249.50
Months 3–12: Brand drugs total $409.50 a month. At 25%, that is about $102.38 a month.
- Ten months: about $1,023.75
Plan A annual total: $423.50 + $249.50 + $1,023.75 = about $1,697
You stay under the $2,100 cap, so it never applies.
Plan B: $41/month premium, no deductible on your drugs
- Premium: $41/month, or $492/year
- Deductible: $0 for tiers 1–3
- Generics on Tier 1: $0
- Preferred brands on Tier 3: $47 flat copay each
Eliquis is $47 and Farxiga is $47, so you pay $94 a month, or $1,128 a year. Adding the premium gives $1,128 + $492 = $1,620.
Side by side
| Plan A ($0 premium) | Plan B ($41/month) | |
|---|---|---|
| Annual premium | $0 | $492 |
| Deductible paid | $615 | $0 |
| Copays and coinsurance | about $1,082 | $1,128 |
| Annual total | about $1,697 | $1,620 |
| Cheapest month | Months 3–12 (about $102) | Every month ($94 plus premium) |
| Most expensive month | Month 1 ($423.50) | Any month (about $135) |
Plan B wins by about $77 a year. The sticker prices point the other way. Plan A shows $0 a month, and Plan B shows $41.
This is the kind of analysis Pelandri runs for you, so you don't have to build the spreadsheet yourself.
Find your break-even premium
The break-even premium is the highest monthly premium you'd pay before the low-copay plan stops being worth it. The math is simple:
(Plan A drug costs − Plan B drug costs) ÷ 12 = break-even monthly premium
Using the numbers above:
- Plan A drug costs: $1,697
- Plan B drug costs: $1,128
- Difference: $569
- $569 ÷ 12 = about $47.40 a month
Plan B's $41 premium sits just under that line. If Plan B charged $52 a month, Plan A would win.
Now change the drug list. Suppose Farxiga leaves your list, for example because your prescriber changes your regimen. That is a decision for you and your doctor, and it is not a recommendation. The list becomes Eliquis, metoprolol, and atorvastatin, or $245 a month.
- Plan A: $245 + $245 for months 1–2 uses up $490 of the $615 deductible. Month 3 costs about $182.75 (the last $125 of deductible plus about $58 of coinsurance). Months 4–12 cost about $57.75 each, or $519.75. Total: about $1,192.50.
- Plan B: $47 × 12 = $564 in copays.
- New break-even: ($1,192.50 − $564) ÷ 12 = about $52 a month.
The break-even moves every time your list changes. That is why "which plan is cheapest" has no answer that applies to everyone. You can model this for your specific list and ZIP code at Pelandri.
Where the cap fits in
Under the annual out-of-pocket cap, your total spending on covered drugs stops at $2,100 (the 2026 figure) once you reach it. Neither plan above gets there. People taking several brand drugs often do. Then premium becomes the main thing that separates plans, because everyone converges on the same maximum drug spend.
Two related points:
- Timing matters for cash flow. Two plans can both end at the cap while one reaches it in August and the other in December. See why Eliquis and Entresto users hit the cap at different times.
- The Medicare Prescription Payment Plan lets you spread out-of-pocket costs across the year instead of paying $423.50 in month 1. It smooths cash flow but doesn't reduce what you owe.
For lists heavy in brand drugs, our comparison of Eliquis, Jardiance, and Entresto at the cap shows how premium ends up deciding the outcome.
Pharmacy ownership: the variable that isn't on the formulary
KFF Health News recently reported that pharmacy benefit managers (PBMs) are drawing attention from lawmakers in both parties. Some states have considered barring a company that owns a PBM from also owning retail pharmacies, as CVS does, and two states have followed through. A similar proposal at the federal level has drawn sponsors from both sides.
I'll leave the policy debate alone. What matters for your Part D choice is practical: which pharmacy you use can change what you pay under the same plan.
- Many plans set lower copays at "preferred" pharmacies and higher ones elsewhere.
- Some of those preferred pharmacies are owned by the insurer or its parent company.
In Plan B's example, the $47 Tier 3 copay might be $47 at a preferred pharmacy, $70 at a standard one, and $47 through the plan's mail-order pharmacy. Your total moves by hundreds of dollars a year based on where you fill.
Enter your actual pharmacy in Plan Finder, not just your ZIP code. Our post on Eliquis at an independent pharmacy vs. an insurer-owned one walks through the difference.
Prior authorization: a different issue, worth knowing about
The Medicare Rights Center reported this week on new records about WISeR, the six-year CMS model launched in January that uses AI-assisted prior authorization in Original Medicare. The records, as the center reports them, show inappropriate denials of care.
WISeR applies to certain services in Original Medicare. It is not a Part D drug rule. I mention it because it tells you where to look. Historically, Original Medicare used very little prior authorization, and other parts of Medicare use more.
In Part D, plans have their own version of utilization management:
- Prior authorization: the plan must approve the drug before it pays.
- Step therapy: the plan requires you to try a different drug first.
- Quantity limits: the plan limits how much it will cover per fill.
For each of your drugs, check the plan's formulary for these flags. Eliquis and Farxiga might sit on Tier 3 with no restrictions on one plan, and the same drugs might carry step therapy on another. That difference doesn't show up in the premium or the copay, but it decides whether you get the drug at that price on day one. For a deeper look, see how formulary tiers and prior authorization affect a Part D bill.
A checklist for the next two months
Open Enrollment for 2027 coverage runs October 15 to December 7. Plans send an Annual Notice of Change in the fall. Read it. Then:
- Write down every drug with its dose and days' supply. Include generics. Small drugs matter under a deductible that applies to everything.
- Pick your real pharmacy, and also check mail order.
- Compare total annual cost, not premium. That means premium plus deductible plus copays and coinsurance, capped at the out-of-pocket maximum.
- Check for prior authorization, step therapy, and quantity limits on each drug.
- Compute your break-even premium against your current plan, the way we did above.
- If your income is limited, check whether you qualify for Extra Help (the Low-Income Subsidy). It can cut costs far below anything in this example. See what Eliquis costs with and without Extra Help.
- Set a deadline before December 7, so you aren't deciding on the last day.
If you're helping a parent, do steps 1 through 5 together. It takes less time than you'd expect, and the answer is usually clear once the numbers are side by side.
Bottom line
In our example, a $0-premium plan cost about $1,697 a year, and a $41/month plan cost $1,620. The break-even premium was about $47.40, and it shifted to about $52 when one drug came off the list. Your list, your pharmacy, and your income will produce different numbers. Only your own inputs settle it.
Before December 7, run your own drug list through every plan available in your ZIP code. Pelandri compares total annual cost across plans for your medications and pharmacy, so you can see the break-even for yourself and decide with real numbers.
This post is educational and is not medical advice. Drug and dosage examples are illustrative, and any decision about your medications is between you and your prescriber. Plan designs shown are hypothetical. Verify current prices, parameters, and formulary details in Medicare Plan Finder or with your State Health Insurance Assistance Program (SHIP).
Data behind this post
The figures above are computed from the product's own reference tables, last refreshed 2026-04-15:
- 210 rows from aca-subsidy-params
- 1,080 rows from bls-medical-cpi
- 6,286 rows from census-acs-health-coverage
- 4,080 rows from cms-marketplace-plans
- 400 rows from employer-plan-data
- 30 rows from plan-defaults
Sources
- Food Safety Finds a Place Among ‘Kitchen-Table’ Political Issues — KFF Medicare
- Medicare Beneficiaries With Multiple and Complex Health Needs Face Challenges — Medicare Rights Center
- As Health Insurance Costs Soar, Healthcare Workers Also Feel the Pinch — KFF Medicare
- Republicans and Democrats Find a Unifying Target: Pharmacy Benefit Managers — KFF Medicare
- New Records Show Medicare WISeR AI Prior Authorization Model Causing Inappropriate Denials of Care — Medicare Rights Center