Eliquis, Jardiance, and Entresto Cost $9,996 a Year — Why the $2,000 Cap Means Your Part D Premium Decides the Rest in 2026
I sat with a client a few years back who was convinced her $0-premium plan was the smart choice. She took a blood thinner, a diabetes drug, and a heart failure medication. By August, she'd already spent more out of pocket than her neighbor on a $55/month plan with the exact same drug list. Nobody had ever shown her the phase-by-phase math — deductible, then coinsurance, then coverage gap, then catastrophic. She just picked the plan with "$0" in big letters.
That neighbor comparison still happens every year, but the math changed in 2025 when Medicare's redesigned Part D benefit eliminated the old donut hole and replaced it with a hard $2,000 out-of-pocket cap. The Medicare Rights Center's recent piece on what's at stake with the Inflation Reduction Act (IRA) lays out why this matters going into 2026: before the IRA, there was no ceiling on what you could pay for drugs in a single year. Now there is. But a cap doesn't mean every plan costs the same to get there — and that's the part most people miss.
Here's the scenario that actually determines your best plan: does your total drug cost this year blow past $2,000 in out-of-pocket spending, or does it stay well below it? The answer changes which plan features matter. Let's walk through both.
Whatever Happened to the Donut Hole?
Quick translation, because the jargon here trips up even people who've had Medicare for a decade:
- Deductible phase — you pay 100% of your drug costs (or your plan's set price) until you hit your plan's deductible, capped at $590 for 2026 under CMS's standard design.
- Initial coverage phase — after the deductible, your plan's formulary tier cost-sharing kicks in: a flat copay or a percentage coinsurance, depending on the plan and the drug's tier.
- The donut hole (coverage gap) — this used to be a separate, painful phase where you suddenly paid a much higher share. As of the 2025 benefit redesign, it's gone. There's no more "you fall in the gap" moment.
- Catastrophic phase — once your TrOOP (True Out-of-Pocket costs — what you personally paid, not counting manufacturer discounts or the plan's share) hits $2,000, your plan covers 100% of covered drug costs for the rest of the calendar year.
So in plain terms: you pay your way through the deductible, then through coinsurance or copays, and the moment your own spending crosses $2,000, you're done paying for the year. That's the whole benefit now. Three phases, one ceiling.
When Your Drug List Blows Past the Cap Anyway
Take a real combination: Eliquis (apixaban) for atrial fibrillation, Jardiance (empagliflozin) for type 2 diabetes, and Entresto (sacubitril/valsartan) for heart failure. Combined list-price drug cost across these three: roughly $9,996 a year, a figure I've walked through in detail in Eliquis, Entresto, and Jardiance's $9,996 drug bill against the $2,000 cap. At that spending level, you are going to hit the $2,000 cap on almost any Part D plan sold in your ZIP code. The only real question is how much it costs you to get there — and that's where premium quietly takes over.
Compare two realistic 2026 plan designs for this exact drug list:
| Plan A (low premium, coinsurance) | Plan B (higher premium, flat copay) | |
|---|---|---|
| Monthly premium | $10 ($120/year) | $55 ($660/year) |
| Deductible | $0 | $590 (applies to brand tiers) |
| Cost-sharing structure | 25% coinsurance, tier 3 | Flat copay after deductible (~$180/month combined) |
| Months to reach $2,000 cap | ~10 months | ~9 months |
| Total out-of-pocket for drugs | $2,000 | $2,000 |
| Total annual cost (premium + OOP) | $2,120 | $2,660 |
Notice something important: both plans cap total drug spending at exactly $2,000, because that's now the law regardless of plan design. The formulary tier, the coinsurance percentage, the deductible size — none of it changes your ceiling once your costs are high enough to clear it. What changes is how much premium you paid to arrive at that same $2,000 ceiling. Plan A wins by $540 a year purely because of a $45-a-month premium difference. This is the same dynamic I found comparing Eliquis and Jardiance side by side in how the IRA's $2,000 cap changes what Eliquis and Jardiance users actually pay, and it holds again when you add Entresto into the mix, as I detailed in Entresto, Eliquis, and Jardiance in the catastrophic phase.
This is exactly the kind of phase-by-phase math Pelandri runs automatically for your actual drug list — so instead of guessing whether your combination clears the cap, you get the month-by-month number.
When Your Drug List Stays Well Under the Cap
Now flip the scenario. A reader on metformin (1000mg), lisinopril (20mg), and atorvastatin (40mg) — three of the most commonly prescribed generics in Medicare — has a very different cost profile. Combined, these drugs typically run a fraction of the brand-name total, often under $50 a month at negotiated generic pricing. This list almost never touches the deductible, let alone the $2,000 cap.
| Plan C ($0 premium) | Plan D ($45/month premium) | |
|---|---|---|
| Monthly premium | $0 | $45 ($540/year) |
| Deductible | Waived for generic tier | Waived for generic tier |
| Combined generic copay | $20/month ($240/year) | $4/month ($48/year) |
| Total annual cost | $240 | $588 |
Here, the cap never enters the picture at all. Nobody hits $2,000 on generics alone in a single year. So the entire comparison comes down to premium versus copay — and in this case, the $0-premium plan wins by $348 a year, even though its copays look "worse" on paper. That's the trap: a plan with higher per-fill costs can still be the better deal if you never come close to needing catastrophic protection. I've walked through a similar generic-heavy comparison in rosuvastatin and gabapentin cost comparisons across formulary tiers, and the pattern repeats: for cheap generic lists, the plan that looks generous on brand-name copays is often overkill.
Put the two scenarios side by side and you can see why "best Part D plan" is a meaningless phrase without a drug list attached:
- Brand-heavy list (Eliquis, Jardiance, Entresto): you'll hit the $2,000 cap regardless of plan — so shop premium.
- Generic-only list (metformin, lisinopril, atorvastatin): you'll likely never hit the cap — so shop copay structure and premium together.
Same market, same ZIP code, completely opposite shopping strategy depending entirely on your medications. You can model this for your specific situation at Pelandri rather than eyeballing which category you fall into.
Why the Policy Noise Doesn't Change Your Enrollment Math This Year
There's a lot happening in Washington around Medicare heading into the fall. MedPAC — the Medicare Payment Advisory Commission — just published its analytic agenda for the 2026–2027 meeting cycle, opening with its September public meeting, and Part D benefit design and payment adequacy are on that agenda. Separately, the Committee for a Responsible Federal Budget's recent analysis, flagged by the Medicare Rights Center, projects roughly $1 trillion in possible Medicare Advantage overpayments over the next decade, a number that's likely to keep pressure on how CMS calibrates plan payments and, indirectly, plan bids and premiums in future years. And with healthcare affordability showing up as a top concern for voters in competitive districts like California's 22nd ahead of November's midterms, per KFF Health News' on-the-ground reporting, Part D design is getting more political attention than it has in years.
None of that changes what you owe this enrollment season. The $2,000 cap, the elimination of the donut hole, and the deductible and coinsurance rules for 2026 are locked in for the plan year you're choosing right now. Policy discussions about future MA payment adjustments or long-term IRA provisions are worth watching — I covered the mechanics of the negotiated pricing itself in Eliquis at $231/month against the $2,000 cap — but they don't retroactively change your 2026 bill. What changes your 2026 bill is which plan you pick between now and December.
What to Actually Do Before Enrollment Closes
Before you default to last year's plan — which is what the majority of Medicare beneficiaries do every single year, even when a cheaper option exists in the same ZIP code — run these numbers for your exact drug list:
- Add up your total annual drug cost at list price. If it's near or above roughly $8,000–$10,000, you're very likely to hit the $2,000 cap on most plans, and premium becomes your primary lever.
- If your list is mostly generics under a few hundred dollars a year, you probably won't hit the cap. In that case, compare premium plus copay structure together, not premium alone.
- Check whether your specific drugs sit on a preferred or non-preferred tier on each plan — tier placement determines coinsurance percentage and copay amount, and it varies plan to plan even for the identical drug.
- Confirm your pharmacy is preferred, not standard, since preferred-network pricing can shift your copay by double digits per fill.
Running this by hand across 20-plus plans in a region is exactly the spreadsheet nobody wants to build twice a year. That's the gap Pelandri exists to close — plug in your actual medications, dosages, and pharmacy, and see the full year's cost, phase by phase, across every plan available where you live, before this fall's Annual Enrollment Period closes on December 7.
Sources
- In Toss-Up House District, Voters Crave Leadership To Fix Broken Healthcare — KFF Medicare
- MedPAC’s analytic agenda for the 2026-2027 meeting cycle — MedPAC
- 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