Eliquis, Jardiance, and Metformin: $1,536 a Year on a $34/Month Part D Plan vs. $1,858 on a $0-Premium Plan (Compare Before December 7)

You take Eliquis 5 mg twice a day, Jardiance 10 mg once a day, and metformin 1,000 mg. Your plan letter arrives in late September, the premium looks about the same as last year, and it is tempting to file it and move on.

Don't. Here is what that same three-drug list costs on two plausible 2027 plan designs, and why the answer flips depending on which drugs are on your list.

Open Enrollment runs October 15 to December 7. Changes take effect January 1. Below I show the full annual math (premium, deductible, copays, and the out-of-pocket cap), then the break-even point that tells you which plan structure fits you.

Why "Same Premium as Last Year" Isn't the Question

Three things changed in the last few years, and they change how you should compare plans:

• The out-of-pocket cap replaced the old donut hole. Under the Inflation Reduction Act (IRA) redesign, the coverage gap is gone. Once your covered Part D spending hits the annual cap ($2,100 in 2026), you pay $0 for the rest of the year. Check the 2027 figure on Medicare Plan Finder, because it is indexed and updated each year.
• Negotiated prices now exist for real drugs. For 2026, Medicare's negotiated prices took effect for the first ten drugs, including Eliquis at $231 per 30-day supply and Jardiance at $197. That lowers the starting price, but your plan still decides how much of it you pay.
• Insulin is capped at $35 a month on covered Part D insulins, regardless of plan. If you use insulin, that piece is the same everywhere. The variation lives in your other drugs.

The negotiated price is the same on every plan. What differs is the deductible, the tier your drug sits on, and whether you pay a flat copay or a percentage. That is where a $0-premium plan quietly costs more.

I covered how the negotiated prices work in Eliquis Is Now a Negotiated Medicare Drug at $231/Month: Which Part D Plan Costs You Less in 2026? and how Jardiance stacks up in Jardiance Costs $564 on One 2026 Part D Plan and $1,179 on Another.

The Worked Example: Two Plans, Three Drugs

These are illustrative plan designs built to reflect common structures, not quotes for a specific plan. Use them to see how the math works, then plug in your real plans.

Assumptions

• Eliquis 5 mg, 60 tablets: negotiated price $231/month
• Jardiance 10 mg, 30 tablets: negotiated price $197/month
• Metformin 1,000 mg, 60 tablets (generic): about $4/month at a standard retail pharmacy
• 2026 standard deductible: $615
• Out-of-pocket cap: $2,100

Plan A: $0 premium

• $615 deductible applies to all drugs, including generics
• After the deductible, brand drugs on Tier 3 cost 25% coinsurance
• Generics: lesser of $10 copay or the drug's actual cost

Plan B: $34/month premium ($408/year)

• $0 deductible on Tiers 1 to 3
• Eliquis and Jardiance each on Tier 3 at a $47 flat copay
• Metformin at $0 (preferred generic)

Scenario 1: Eliquis + metformin

Plan A, month by month:

• January and February: you pay full price. About $235 a month ($231 Eliquis plus $4 metformin), so $470 total toward the deductible.
• March: you have $145 of deductible left. You pay that $145, then 25% of the rest of the Eliquis fill. Roughly $171 for the month.
• April through December (9 months): Eliquis at 25% of $231 is $57.75, plus $4 for metformin. That's $61.75 × 9 = $556.

Plan A total cost-sharing: about $1,197. Premium: $0. Annual total: about $1,197.

Plan B:

• Eliquis $47 × 12 = $564
• Metformin $0
• Premium $408

Annual total: $972.

Plan B wins by roughly $225 even though it charges $34 a month.

Scenario 2: Add Jardiance

Now the full list, Eliquis + Jardiance + metformin.

	Plan A ($0 premium)	Plan B ($34/month)
Premium	$0	$408
Deductible phase (Jan to Feb)	$615 reached by mid-February	$0
Eliquis after deductible	25% = $57.75/mo	$47/mo
Jardiance after deductible	25% = $49.25/mo	$47/mo
Metformin	about $4/mo	$0
Total cost-sharing	about $1,858	$1,128
Annual total	about $1,858	$1,536
Hits the $2,100 cap?	No	No

The gap is roughly $322 a year in favor of the plan with the premium. Neither plan reaches the cap, which is why the cap alone doesn't save you from a poorly matched plan. The cap protects you from catastrophe. It does not protect you from a $0-premium plan with a deductible that eats your first two months.

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

The Break-Even Point: When the $0-Premium Plan Actually Wins

The premium plan isn't always better. Here is the rule I use with clients.

Plan B (higher premium, low copays) wins when your cost-sharing on Plan A exceeds Plan B's cost-sharing plus the extra $408 in premiums.

Test it by changing the drug list:

• Generics only (metformin, atorvastatin, lisinopril): On Plan A you pay roughly $10 a month or less per drug, since most cost less than the copay and never come close to the $615 deductible. Say $120 to $360 a year. On Plan B you pay $0 in copays but $408 in premiums. Plan A wins by about $50 to $290.
• One brand drug (Eliquis): Plan B wins by about $225, as shown above.
• Two or more brand drugs: The gap widens to $322 or more, because each brand drug adds coinsurance on Plan A but only a flat copay on Plan B.

The pattern: the more brand-name drugs on your list, the more a low-deductible, flat-copay plan pays off. The more generics-only your list is, the more a $0-premium plan makes sense. That is exactly why comparing on premium alone misleads people. Two neighbors in the same ZIP code can need opposite answers.

Coinsurance versus flat copay matters as well. If a plan charges 25% on a drug that later gets a higher list price, your share grows with it. A flat $47 doesn't. Check the tier and the cost-sharing type for every drug, not just the premium.

Where the Spread Really Comes From

I've seen the same drug cost $12 on one plan and $340 on another in the same ZIP code. The drivers are:

1. Deductible design. Some plans apply the deductible to every tier. Others exempt Tiers 1 to 3. On a $615 deductible, that difference alone is up to $615 in front-loaded spending.
2. Tier placement. The same drug can sit on Tier 3 on one formulary and Tier 4 or 5 on another.
3. Pharmacy network. Preferred pharmacies often carry lower copays. If you fill at a non-preferred pharmacy, you may pay more for the identical fill. Details on that in Eliquis Costs $2,000 at an Independent Pharmacy vs $3,130 at Your Insurer's Own Pharmacy.
4. Utilization rules. Prior authorization, step therapy, and quantity limits can block or delay a fill even when the drug is "covered."

What the Recent Coverage Says About Who Gets Hurt Most

Several recent stories point to the same problem from different angles.

The Medicare Rights Center's coverage of new KFF polling, "Medicare Beneficiaries With Multiple and Complex Health Needs Face Challenges," focuses on access and affordability struggles among adults with multiple or complex conditions, including older Medicare beneficiaries. That group is exactly the one with the longest drug lists. A longer list means more places where a tier, deductible, or utilization rule can go wrong, so a plan mismatch compounds.

Prior authorization is part of that. Medicare Rights Center's report, "New Records Show Medicare WISeR AI Prior Authorization Model Causing Inappropriate Denials of Care," describes how Original Medicare has historically used very little prior authorization, but CMS launched the six-year WISeR model in January. The article's focus is on the model's effect on care access. It's a useful reminder that coverage rules can change on your terms, not just your plan's. For Part D, the practical takeaway is to check each drug for prior authorization and step-therapy flags on the plan's formulary before you enroll, not at the pharmacy counter in January.

And KFF Health News reporting, "As Health Insurance Costs Soar, Healthcare Workers Also Feel the Pinch," shows what happens when premiums climb faster than budgets: even people who understand the risks make trade-offs, including going uninsured. Medicare Part D works differently, but the instinct is similar: when a plan's monthly premium looks lower, people take it. The Eliquis and Jardiance math above shows why that instinct can cost several hundred dollars a year.

How Pelandri's Data Frames the Premium-vs-Cost-Sharing Trade-Off

Pelandri's analysis draws on 12,086 rows across six datasets. Most of them describe the broader health coverage market rather than Part D specifically, but they inform the same trade-off:

• Our cms-marketplace-plans dataset (4,080 rows) documents how premium, deductible, and cost-sharing vary against each other across plans, the same tension you face between a $0-premium and a $34/month Part D plan.
• The bls-medical-cpi dataset (1,080 rows) tracks medical price inflation over time, which is why coinsurance-based drug pricing tends to drift up while flat copays hold steady.
• plan-defaults (30 rows) and aca-subsidy-params (210 rows) capture how plan design defaults and income-based subsidy parameters shape what people actually pay.
• The census-acs-health-coverage dataset (6,286 rows) shows how coverage varies by geography, which matters because your ZIP code determines which plans you can even choose from.

None of these substitute for the CMS Part D formulary files, which are what determine your specific drug tiers. Use them for context and use Plan Finder or Pelandri for the plan-by-plan numbers.

Your Four Variables (and How to Run the Numbers)

To find your best plan, you need four inputs:

1. Your drug list, with dose and quantity. Include generics. They matter for the break-even.
2. Your pharmacy. Preferred versus standard, retail versus mail order.
3. Your income level. If your income and resources are below the Extra Help thresholds, your costs can be far lower than either plan above. See Eliquis, Jardiance, and Insulin Cost $1,715 Without Extra Help vs. $437 With It for how that changes the math.
4. Your ZIP code, which sets the plans available to you.

Then, for each plan, calculate:

Annual premium + deductible spending + copays or coinsurance after the deductible = total annual cost.

If the total gets near the annual cap, count that plan's cost as the premium plus the cap. Everything above that is $0 for you.

You can model this for your specific situation at Pelandri, which pulls your drug list, pharmacy, and ZIP code into one side-by-side annual total.

If cash flow is the concern rather than the annual total, ask about the Medicare Prescription Payment Plan. It spreads your out-of-pocket costs across monthly payments instead of front-loading them in January and February. It doesn't lower your annual cost, but it can soften the early-year hit on a plan with a full deductible.

A Checklist Before December 7

• Get your Annual Notice of Change from your current plan. It shows what changes for 2027.
• Check your drug tiers for every medication, including generics.
• Check for prior authorization or step therapy on each drug.
• Compare at least three plans on total annual cost, not premium.
• Confirm your pharmacy's status on each plan.
• Look at the 2027 cap and deductible on Medicare Plan Finder, since these figures are updated yearly.
• Enroll by December 7. Your new coverage begins January 1.

If a family member helps you with this, give them the list and the plan documents now. A December 6 scramble is the most common way people end up rolling over a plan that no longer fits.

The Bottom Line

On the illustrative plans above, a $34/month plan costs $1,536 a year for Eliquis, Jardiance, and metformin, versus $1,858 on a $0-premium plan, a difference of about $322. Drop the brand drugs and the answer reverses. Your list decides, not the premium.

The negotiated prices and the out-of-pocket cap made Part D better, but they did not make every plan equal. Deductibles, tiers, and pharmacy networks still swing the annual bill by hundreds of dollars.

Before December 7, run your own list through every plan available in your ZIP code. Compare plans for your medications at Pelandri and see the full annual total for each one, so you choose on cost rather than on the premium alone.

This article is educational and is not medical advice or a drug recommendation. Plan designs shown are illustrative examples. Verify tiers, prices, and 2027 program parameters on Medicare Plan Finder and your plan's formulary before enrolling.

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

• Medicare Beneficiaries With Multiple and Complex Health Needs Face Challenges — Medicare Rights Center
• Journalists Discuss What RFK Jr. Recently Told the Anti-Vaccine Group He Founded — KFF Medicare
• New Records Show Medicare WISeR AI Prior Authorization Model Causing Inappropriate Denials of Care — Medicare Rights Center
• Abortion Is on the Ballot Again as Post-Roe Policies Continue To Evolve — KFF Medicare
• As Health Insurance Costs Soar, Healthcare Workers Also Feel the Pinch — KFF Medicare