Eliquis at $231/Month, Farxiga at $178.50/Month: Comparing 2026 Part D Plans Now That Both Drugs Are Negotiated

You take Eliquis 5mg twice a day for atrial fibrillation, Farxiga 10mg once a day for your heart failure and kidneys, and metformin for blood sugar. Your neighbor takes the exact same three drugs. You're both comparing 2026 Part D plans in the same ZIP code. And even though both of your drugs are now on Medicare's negotiated price list — a real, substantial win from the Inflation Reduction Act — you can still end up paying nearly $180 more than she does for the year, just because you picked the plan with the fancier copay structure instead of running the actual numbers.

That gap is the whole reason this post exists. Let's do the math.

What the IRA actually locked in for 2026

Before we get to the plan comparison, it's worth being precise about what changed, because a lot of the coverage this fall — including the Medicare Rights Center's recent rundown, "What's at Stake in 2026: The Inflation Reduction Act" — has been about whether these protections hold going forward. Setting the politics aside, here's what's true for the 2026 plan year as written into current law and CMS's published Part D parameters:

• The annual out-of-pocket cap is $2,100. Once your true out-of-pocket costs (TrOOP) for covered drugs hit that number, you pay $0 for the rest of the calendar year. No more separate "coverage gap" or "donut hole" math — Medicare collapsed the old multi-phase design into one continuous cost-sharing period followed by a hard stop.
• Eliquis (apixaban) has a Medicare-negotiated maximum fair price of $231/month. It was one of the first ten drugs negotiated under the IRA, effective for 2026.
• Farxiga (dapagliflozin) has a negotiated price of $178.50/month. Same negotiation round, same effective date.
• Metformin is a low-cost generic and typically runs $4-8/month depending on the plan's tier placement — we'll use $5.

Those negotiated prices are a real reduction from list price. But here's the part that gets lost in the headlines: the negotiated price is the ceiling on what the drug costs the plan — it is not what you pay. What you pay depends entirely on your plan's deductible, its coinsurance percentage, and how your specific drugs are tiered. That's the variable Medicare didn't standardize, and it's the one Open Enrollment exists to let you shop.

The worked example: three plans, same three drugs

Using CMS's 2026 standard Part D deductible of $615 and a combined monthly formulary cost of $414.50 for this drug list (Eliquis $231 + Farxiga $178.50 + metformin $5), here's what three realistic plan designs produce over a full year.

	Plan A: $0 premium, standard deductible	Plan B: $42/mo premium, $0 deductible	Plan C: $87/mo premium, enhanced copays
Annual premium	$0	$504	$1,044
Deductible	$615 (standard)	$0	$0
Cost-share after deductible	25% coinsurance	25% coinsurance (brand tiers)	Fixed $35 copay per brand drug/month
Metformin cost-share	Included in coinsurance	$0 (preferred generic)	$0
Annual drug out-of-pocket	$1,704.75	$1,228.50	$840.00
Total annual cost (premium + drug OOP)	$1,704.75	$1,732.50	$1,884.00

Notice what happened: on this drug list, nobody actually reaches the $2,100 out-of-pocket cap. The negotiated prices brought the combined annual drug cost down to about $4,974 — low enough that even Plan A's 25% coinsurance only adds up to $1,704.75 in out-of-pocket spending for the year, well under the cap. That's a meaningful, IRA-driven improvement over what this same drug list would have cost in 2023.

But it also means the cap isn't doing any work for you here — the plan's design is the entire ballgame. And the plan with the richest-looking copay structure (Plan C, with tidy $35 flat copays instead of scary-sounding coinsurance) is actually the most expensive option by $179.25 a year, because its premium outpaces the copay savings. Plan B, the "no deductible" plan that sounds like the safe middle choice, still loses to the $0-premium plan with a deductible by $27.75.

This is the exact trap covered in more detail in Medicare's $2,000 Drug Cap Explained — a low sticker-price premium and a high one can each be the better deal depending entirely on whether your drug spending is high enough to reach the cap. For a costlier drug list — say Eliquis plus Jardiance plus a specialty drug — the math flips, because you will blow through $2,100 in the first few months and premium becomes the only variable left. That scenario is walked through in Eliquis and Jardiance Cost $9,996 a Year. The point isn't that one plan type always wins — it's that you cannot know which structure wins for your list without running the calculation on your actual drugs.

This is the kind of analysis Pelandri runs for you — you plug in your medications, dosages, and ZIP code, and it builds this exact table across every plan available to you, instead of you eyeballing a Summary of Benefits PDF.

Why the $0-premium Medicare Advantage plan isn't automatically the deal it looks like

There's a second layer here that's been in the news lately, and it's directly relevant to how you should be comparing plans this fall. The Medicare Rights Center's recent piece "Evidence of MA Overpayment Continues to Mount" cites a Committee for a Responsible Federal Budget analysis projecting up to $1 trillion in Medicare Advantage overpayments over the next decade relative to what those same enrollees would cost in traditional Medicare. CRFB's underlying data shows MA enrollment and federal spending on MA both climbing faster than the cost trends would predict if payment accuracy were the only driver.

Why does that matter to you, specifically, when you're comparing drug plans? Because a $0-premium Medicare Advantage plan that bundles Part D coverage is being subsidized by a payment structure that doesn't necessarily translate into better formulary generosity for your Eliquis and Farxiga. The overpayment shows up as insurer margin and extra supplemental benefits (dental, vision, gym memberships) — not automatically as lower drug tier placement or lower specialty coinsurance. A standalone Part D plan (PDP) paired with original Medicare, or a different MA-PD plan in your area, can genuinely beat a $0-premium MA plan on your specific drug math, even though the MA plan's premium line looks unbeatable on the surface.

If you're weighing Medicare Advantage against a Medigap-plus-standalone-PDP setup for a similar three-drug list, the full annual comparison — including how MA cost-sharing and PDP cost-sharing diverge for these exact drugs — is broken down in Medigap Plan G vs. Medicare Advantage for Eliquis, Metformin, and Atorvastatin. The short version: the premium you see in the plan brochure and the total annual cost for your drug list are frequently two different rankings entirely.

One more thing before you trust a "lower price" headline

There's been a wave of coverage this year about industry deals touted as consumer wins — drug pricing agreements, changes to prior authorization rules, and similar announcements. KFF Health News' recent reporting, "Trump and Kennedy's Health Industry Deals Haven't Been Enforced and Are at Risk of Vanishing," is a useful reality check: agreements announced with fanfare don't automatically show up as enforceable terms in your actual plan documents. The same caution applies to Part D. A negotiated federal price for Eliquis or Farxiga is real and binding — it's law, not a press release — but a manufacturer coupon, a "we lowered our list price" announcement, or a headline about a pharmacy discount deal is not the same thing as your plan's formulary tier and copay for that drug. Always confirm the actual cost-sharing on your plan's current formulary rather than assuming a favorable-sounding announcement applies to you. This is the same trap covered in Eliquis at $280/Month on GoodRx vs. $47/Month Through Part D — discount programs and Part D cost-sharing run on entirely separate tracks, and only one of them counts toward your $2,100 cap.

How to actually run this for your own drug list

The math above works for one specific combination — Eliquis, Farxiga, and metformin, at 2026 negotiated prices, across three representative plan designs. Change any one variable — a different drug, a different dose, a preferred vs. standard pharmacy, your income level and Extra Help eligibility, or your ZIP code's specific plan lineup — and the ranking can flip entirely. That's not a hedge; it's the actual structure of Part D. Pelandri's underlying comparison engine draws on CMS marketplace plan filings, published Part D deductible and catastrophic-threshold parameters, and current formulary data to run exactly this calculation — premium, deductible, initial coverage, and the $2,100 cap — against your real medication list, not a generic example.

You can model this for your specific situation at Pelandri. Enter your drugs, your dosages, your pharmacy, and your ZIP code, and you'll get the same kind of side-by-side annual total shown above — built for your list, not a stand-in.

Open Enrollment runs seven weeks. Most people default to whatever plan they had last year, and for a drug list like this one — where the cheapest and most expensive plans are separated by only $179 a year but the wrong choice still costs you real money every month — that default is exactly the decision worth double-checking before the window closes.

Sources

• What’s at Stake in 2026: The Inflation Reduction Act — Medicare Rights Center
• Evidence of MA Overpayment Continues to Mount — Medicare Rights Center
• With Midterms Looming, Journalists Consider Measles, Food Recalls, and Obamacare — KFF Medicare
• Trump and Kennedy’s Health Industry Deals Haven’t Been Enforced and Are at Risk of Vanishing — KFF Medicare
• High Fertility Costs Push Americans Abroad for IVF Treatment — KFF Medicare