Eliquis and Jardiance Cost $1,851 on a $0-Premium Part D Plan vs. $426 With Extra Help: What to Check Before the December 7 Deadline

You are 71. The nearest pharmacy is a 40-minute drive. You take Eliquis 5 mg twice a day, Jardiance 10 mg once a day, atorvastatin 40 mg, and metoprolol succinate 50 mg. Your plan's Annual Notice of Change was due in your mailbox by September 30, and it says your premium is still $0.

That $0 is the number most people stop reading at. Here is what the same four prescriptions cost over a full year in the model below:

• $1,851 on a $0-premium plan with a deductible
• $1,644 on a $39/month plan with flat copays
• $426 with Extra Help, the federal Low-Income Subsidy (LIS)

Open Enrollment runs October 15 to December 7 for coverage starting January 1, 2027. That gives you about two weeks before it opens and seven weeks once it does. This post walks through the math so you can rerun it with your own list.

What this week's reading has in common

I read five recent pieces for this post. Three of them matter for your drug bill.

The KFF–Associated Press survey of rural voters found that people say the sweeping health initiatives championed under the Make America Healthy Again banner haven't reached their communities. I'm not going to weigh in on the politics. The practical lesson for a Part D enrollee is that a benefit only counts if you can use it. A "preferred pharmacy" 45 miles away is a benefit on paper only.

KFF Health News's explainer on hospital charity care describes why some states now make hospitals identify eligible patients and enroll them automatically. The application forms are so cumbersome that people who qualify never finish them. Medicare has the same problem with Extra Help, covered below.

The Medicare Rights Center's September 24 write-up of new KFF polling looks at adults with multiple or complex health conditions, including older Medicare beneficiaries. It describes access and affordability challenges for that group. A four-drug list like the one above is where plan design hurts most, because every drug lands on its own tier and runs through the same deductible.

The other two pieces were lighter. KFF Health News is running its eighth annual Halloween haiku contest, and it publishes a weekly KFF Health News Minute. Here is my entry for the scariest 17 syllables in Part D:

Sticker shock, again. Deductible not yet met. Pharmacy says: full price.

(The contest rules are on the KFF Health News site if you'd like to enter yours.)

Four dials decide your bill

Every comparison of Part D plans comes down to four personal variables:

1. Your drug list. Each drug gets its own tier and price.
2. Your pharmacy choice. Preferred retail, standard retail, or mail order can price the same drug differently under the same plan.
3. Your income. It decides whether you qualify for Extra Help.
4. Your ZIP code. It decides which plans you can choose from and which pharmacies are preferred.

A $0-premium sticker tells you nothing about three of the four.

A note on method. Pelandri's data layer holds 12,086 rows across six sources: aca-subsidy-params (210 rows), bls-medical-cpi (1,080), census-acs-health-coverage (6,286), cms-marketplace-plans (4,080), employer-plan-data (400), and plan-defaults (30). Those sources are weighted toward marketplace and coverage data, not Part D formulary files. What they do show is that plan files list premium, deductible, and cost-sharing as separate fields. That is why premium alone never predicts the annual total. The drug-level figures below come from published Part D design parameters and an illustrative model, not from a specific named plan. Plug in your own plans from Medicare Plan Finder.

The worked example: one drug list, three outcomes

Assumptions (2026 Part D parameters as the template; 2027 figures shift slightly):

• Eliquis at its Medicare-negotiated price of $231 per 30-day supply
• Jardiance at its negotiated price of $197 per 30 days
• Atorvastatin and metoprolol at roughly $6 each per month
• Standard deductible up to $615
• Out-of-pocket cap of $2,100
• Gross monthly drug cost: $231 + $197 + $6 + $6 = $440

Plan A ($0 premium): The $615 deductible applies to every drug, generics included. After the deductible, brand drugs carry 25% coinsurance and generics a $5 copay.

• January: you pay the full $440.
• February: you pay the remaining $175 of deductible. The brand claims left over (about $265) then cost 25%, or $66.25.
• March through December: 25% of $428 in brand claims is $107, plus $10 in generic copays. That is $117 a month, or $1,170 over ten months.
• Total: $615 + $66.25 + $1,170 = $1,851.

Plan B ($39/month): No deductible. Eliquis and Jardiance are Tier 3 at a $47 copay each, and generics are $2 each.

• Premium: $468
• Brand copays: $94 × 12 = $1,128
• Generic copays: $4 × 12 = $48
• Total: $1,644

Extra Help, in a benchmark-premium plan:

• 2026 copays are at most about $12.65 per brand fill and $5.10 per generic fill.
• Monthly: ($12.65 × 2) + ($5.10 × 2) = $35.50.
• Premium is $0 in a qualifying plan, and there is no deductible.
• Total: $426.

	Plan A: $0 premium	Plan B: $39/month	Extra Help
Annual premium	$0	$468	$0
Deductible phase	$615	$0	$0
Copays and coinsurance after that	$1,236	$1,176	$426
Total annual cost	$1,851	$1,644	$426
Counts toward the $2,100 cap (TrOOP)	$1,851	$1,176	$426

Two things stand out. First, neither plan ever reaches the $2,100 cap. Coverage of the cap often implies it shields everyone from big bills. It doesn't if your drugs have modest negotiated prices and your plan has a deductible. Second, premiums don't count toward the cap. TrOOP (true out-of-pocket) tracks only what you pay for covered drugs.

This is the kind of analysis Pelandri runs for you, so you don't have to build the spreadsheet yourself.

Where the $0 plan loses, and where it wins

The $39 plan beats the $0 plan by $207 in this scenario. The break-even points are:

• Premium break-even: Plan B stays cheaper until its premium reaches about $56/month. That is $1,851 minus $1,176 in copays, divided by 12.
• Copay break-even: At a $39 premium, Plan B stays cheaper until its Tier 3 copay reaches about $55.60. Above that, the $0-premium plan wins.

Flip the scenario and the $0 plan can win. Suppose you only take generics. The deductible barely matters, and a $468 premium would be hard to justify. The answer depends on your list, which is why "the cheapest plan" is not a fact you can look up. It's a calculation you have to run.

For other drug lists with the same pattern, see how a $0-premium plan compared with a $38/month plan for Eliquis and Jardiance with mail order and tier exceptions. If you have several conditions, this four-drug heart failure comparison shows how a longer list changes the answer.

The pharmacy dial: preferred retail vs. mail order

Rural readers should read this part twice. Using Plan B, I priced the same four drugs three ways. The assumptions are illustrative:

• Standard retail: $47 per Tier 3 fill.
• Preferred retail: $35 per Tier 3 fill, with $0 generics.
• Mail order: a 90-day supply for the price of two preferred fills ($70), with $0 generics. This is a common design, but check yours.

Where you fill	Eliquis + Jardiance	Generics	Premium	Annual total
Standard retail	$1,128	$48	$468	$1,644
Preferred retail	$840	$0	$468	$1,308
Mail order (90-day)	$560	$0	$468	$1,028

Same plan, same drugs, same ZIP code. The gap between filling at your local standard pharmacy and using mail order is $616 a year.

Mail order is also the answer to the access problem the rural survey describes. If the preferred pharmacy is 45 minutes away, a three-month supply that arrives at your door removes the drive. Before you commit, check three things:

• Which pharmacies are "preferred" in your ZIP code. Many are insurer-owned. This comparison of an independent pharmacy and an insurer-owned one shows how much that can matter.
• Whether your plan covers 90-day supplies of every drug on your list.
• Whether your pharmacy coupons help or hurt. A discount-card price doesn't count toward your $2,100 cap. See why coupons can backfire.

You can model your own pharmacy options at Pelandri.

Extra Help: the benefit you have to apply for

Extra Help is the federal program that cut the same list from $1,851 to $426. It waives the deductible, pays your premium up to a regional benchmark, and caps copays at a few dollars per fill.

Since 2024, full benefits go to anyone under 150% of the federal poverty level. In round numbers for 2026, that is about $24,000 a year for a single person and about $32,000 for a married couple. Countable resources must also be under a limit, roughly $17,600 for one person (check the current figure with Social Security). Your home, one car, and personal belongings don't count.

This is where the hospital charity-care story applies. KFF Health News reports that eligible patients miss out when the paperwork is the gatekeeper. Extra Help works the same way:

• If you're on Medicaid, SSI, or a Medicare Savings Program, you're deemed eligible automatically. You'll get a letter from CMS.
• If you aren't, you must apply at ssa.gov/extrahelp or by calling Social Security at 1-800-772-1213. Nobody enrolls you.

If you qualify, you can also switch into a standalone Part D plan once a month, not only during Open Enrollment. And if you recently lost Medicaid, your deemed status may be changing. This breakdown of the Medicaid work requirement explains what that does to the same drug list.

Caregivers: if a parent's income is near the line, run the application anyway. Here is what the numbers look like with and without it.

The tier exception: a lever for the drug that's priced wrong

Suppose Plan B put Jardiance on Tier 4 at $95 instead of Tier 3 at $47. That is $48 more per month, or $576 over a year. Switching plans isn't your only option. You can ask for a tiering exception, which asks the plan to price your drug at a lower tier's cost-sharing.

How it works:

• Your prescriber submits a supporting statement saying why the lower-tier alternatives wouldn't work as well for you or would be harmful.
• The plan generally has to answer within 72 hours (24 hours if expedited).
• It only works when the plan has lower-tier alternatives for your condition.
• It's not available for every tier. Specialty-tier drugs are generally excluded.

If approved, the lower price typically holds for the rest of the plan year. I'm describing the process, not recommending any drug. Medical decisions belong to you and your prescriber.

Your checklist before December 7

1. Open your Annual Notice of Change. Compare its drug tiers and deductible to what you paid last year.
2. Write down your full drug list with doses and quantities, including generics.
3. Choose your pharmacy and check which plans treat it as preferred.
4. Price mail order for every maintenance drug.
5. Check Extra Help eligibility. If you're not automatically deemed, apply.
6. Compare total annual cost: premium plus deductible plus copays. Don't compare premiums alone.
7. Make the switch by December 7. Coverage for 2027 locks in on that date.

The bottom line

Same four drugs, same ZIP code, and a $1,425 spread between the $0-premium plan and Extra Help. A further $616 hangs on where you fill the prescriptions. These aren't tricks. They are published plan features that most people never price, because the sticker premium is the easiest number to read.

Your numbers will differ. Your list, your pharmacy, your income, and your ZIP code each move the answer. Compare your own plans at Pelandri before Open Enrollment closes December 7. Enter your medications and pharmacy, and see your total annual cost side by side.

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

• Rural MAHA Followers Say Trump Health Policies Haven’t Reached Their Communities — KFF Medicare
• Hospitals Have a Little-Known Tool To Prevent Medical Debt. Here’s How It Works. — KFF Medicare
• Healthcare Is Scary. Channel Your Fears Into a Haiku. — KFF Medicare
• Medicare Beneficiaries With Multiple and Complex Health Needs Face Challenges — Medicare Rights Center
• Listen to the Latest ‘KFF Health News Minute’ — KFF Medicare