Eliquis and Jardiance Worked Example: $1,488 a Year on a $34/Month Part D Plan vs. $1,865 on a $0-Premium Plan (Compare 2027 Plans Before December 7)
You take Eliquis 5 mg twice a day, Jardiance 10 mg once a day, metformin 500 mg, and atorvastatin 20 mg. Your current Part D plan has a $0 premium, and you're wondering whether it's worth the trouble of comparing 2027 plans.
Here is what that same four-drug list costs across three modeled Part D plans: $1,488 on the cheapest, $1,655 on the middle one, and $1,865 on the $0-premium plan. That's a $377 spread for identical medications, and the plan with no monthly premium came out most expensive.
These are illustrative plan designs, not quotes for a real plan in your ZIP code, and this list is an example, not a recommendation about what anyone should take. The point is the method. Once you see how the pieces interact, you can run it for your own list.
Open Enrollment runs October 15 to December 7, 2026 for 2027 coverage. Plans must send their Annual Notice of Change letters by the end of September, and 2027 plan details should be searchable in Medicare Plan Finder around the start of October. If a letter has arrived, read it.
Why This Fall Feels Different
In KFF Health News' "Sticker Shock at the Doctor's Office Could Motivate Midterm Voters," chief Washington correspondent Julie Rovner describes steep jumps in premiums and deductibles as top of mind for many voters. I'll leave the election talk to others. What I'll say is that this is the one part of your 2027 bill you can act on directly. Your Part D plan choice is a decision you make in the next 11 weeks, and it can move your annual drug spending by hundreds of dollars.
Two other stories in this week's reading connect to that decision.
Medicare eligibility is changing for some immigrants. Medicare Rights Center's post, "Thousands of Immigrants Scheduled to Lose Medicare Coverage in the New Year," describes its comments on a proposed CMS rule implementing eligibility changes under H.R. 1. The rule is still proposed, so details may change. The practical point for this post is narrow. A Part D plan only works while you have Medicare Part A or Part B to attach it to. If you or a family member might be affected, confirm your coverage status and end date with Social Security or 1-800-MEDICARE before you pick a 2027 plan. Don't assume the plan you choose in November will be in force in March.
State Medicaid decisions can ripple into drug costs. KFF Health News reports in "Cost-Saving Medicaid Meal Deliveries Threatened by Cuts, Policy Uncertainty" that Medicaid budget pressure could lead states to reconsider covering food for sick residents, and one state already has. If you're dually eligible for Medicare and Medicaid, your Extra Help (the Low-Income Subsidy, which cuts Part D costs sharply) is tied to that Medicaid status. Our post on Eliquis and Jardiance with Extra Help and the Medicaid work requirement walks through what changes if your Medicaid status does.
The Ground Rules I Used
Some Part D terms, in plain English:
- Deductible: what you pay in full before the plan starts sharing costs. The 2026 standard maximum is $615, and plans can charge less. Many plans skip it for generics.
- Tier: the price bracket your plan puts each drug in. Tier 1 is usually cheap generics. Tier 3 is "preferred brand." Tier 4 is "non-preferred brand," which typically costs you more.
- Out-of-pocket cap: once you've spent a set amount on covered drugs, you pay $0 for the rest of the year. It was $2,000 in 2025 and $2,100 in 2026. Confirm the 2027 figure in Plan Finder. Insurers call the amount you've accumulated "TrOOP" (true out-of-pocket). Our explainer on how the cap works with Eliquis covers the mechanics.
- The donut hole: gone since 2025. There's no gap phase anymore, just the deductible, the cost-sharing phase, and the cap.
Drug prices used. I used the 2026 Medicare-negotiated prices as the base for calculating coinsurance: Eliquis at $231 per 30 days and Jardiance at $197 per 30 days, so $428 a month, or $5,136 a year, for the two brands. Real plans add or subtract pharmacy fees, and 2027 negotiated prices are adjusted from these, so treat them as a reasonable stand-in.
Metformin and atorvastatin are generics on Tier 1.
Three Plans, One Drug List
| Plan A | Plan B | Plan C | |
|---|---|---|---|
| Monthly premium | $0 | $34 | $22 |
| Annual premium | $0 | $408 | $264 |
| Deductible | $615 (brand tiers) | $0 | $0 |
| Eliquis | Tier 3, 25% after deductible | Tier 3, $45 copay | Tier 3, $47 copay |
| Jardiance | Tier 3, 25% after deductible | Tier 3, $45 copay | Tier 4, 35% |
| Generics (2 drugs) | $5 each per fill | $0 | $0 |
Plan A math (the $0-premium plan):
- Month 1: you pay the whole $428 toward the deductible.
- Month 2: you pay the remaining $187 of the deductible, plus 25% of the other $241 ($60.25). That's $247.25.
- Months 3 to 12: 25% of $428 is $107 a month, or $1,070 over ten months.
- Brand total: $1,745.25.
- Add $120 for generics ($5 × 2 drugs × 12 months).
- Annual total: $1,865.25. That's under the $2,100 cap, so the cap never kicks in.
Plan B math (the $34/month plan):
- Premium: $408.
- Brand copays: $45 × 2 drugs × 12 months = $1,080.
- Generics: $0.
- Annual total: $1,488.
Plan C math (the $22/month plan):
- Premium: $264.
- Eliquis: $47 × 12 = $564.
- Jardiance at 35% of $197 is $68.95 a month, or $827.40 a year.
- Annual total: $1,655.40.
| Plan | Premium | Drug cost-sharing | Annual total |
|---|---|---|---|
| A ($0 premium) | $0 | $1,865.25 | $1,865.25 |
| B ($34/month) | $408 | $1,080 | $1,488.00 |
| C ($22/month) | $264 | $1,391.40 | $1,655.40 |
Plan C shows a trap I saw constantly in counseling. Its lower premium looks like savings, but one drug landed on a higher tier, and that erased the premium advantage and then some. Plan Finder shows tier and cost per drug, but you have to enter the whole list to see it.
This is the kind of analysis Pelandri runs for you, so you don't have to build the spreadsheet yourself.
What January Feels Like on Each Plan
Annual totals hide the cash flow. Monthly out-of-pocket costs, including premiums:
| Month | Plan A | Plan B |
|---|---|---|
| January | $438 ($428 + $10 generics) | $124 |
| February | $257.25 | $124 |
| March through December | $117 each | $124 each |
Plan A costs $438 the first time you go to the pharmacy in January, then $257 in February, then settles around $117. Plan B is $124 every month. If a $438 January fill would force you to skip or split doses, say so to your pharmacist and your plan before you reach that counter. The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the year in monthly installments instead of paying at the counter. It doesn't lower your annual total, but it can fix a cash-flow problem. Ask your plan about it during enrollment.
Where Does the Premium Pay for Itself?
The most useful number here is the break-even: how much brand-drug spending it takes before paying a premium beats a $0 premium.
Using Plan A and Plan B as designed:
- No brand drugs, generics only: Plan A costs $120 and Plan B costs $408. The $0-premium plan wins by $288.
- One brand drug at $231 a month (Eliquis alone): Plan A costs $1,274.25 and Plan B costs $948. Plan B wins by $326.25.
- Two brands (Eliquis plus Jardiance): Plan B wins by $377.25.
For a single brand drug on Plan A's design, the yearly cost works out to about $581.25 plus three times the drug's monthly price. Plan B stays at $948. They cross at roughly $122 a month. In this example, if your one brand drug costs more than about $122 a month at the plan's negotiated price, the $34 premium plan wins. Below that, $0 premium wins.
Notice that the second brand drug added only about $51 to Plan B's advantage. The break-even sits low, so the first expensive brand drug does most of the work of tipping the choice. The cap is a different story. Once your list is expensive enough to reach it, everyone on every plan pays the same cap amount, and the premium becomes the main differentiator. In that world the lower-premium plan usually wins. I covered that scenario in the Eliquis, Jardiance, and Entresto cap analysis.
The Four Variables That Decide Your Answer
The table above is only one household's answer. Four personal inputs move the result.
1. Your drug list, including doses. A drug's tier, and whether it needs prior authorization or step therapy (trying a cheaper drug first), is set plan by plan. The same drug can be Tier 3 on one plan and Tier 4 on another, and that alone produced the $167 gap between Plans B and C. Enter every medication, including the cheap ones. Generics can carry different copays by plan.
2. Your pharmacy. Many plans charge less at "preferred" pharmacies and at mail order. Some insurers own pharmacies that may or may not be preferred on their own plan. If your local pharmacy isn't preferred on a plan, model the price at the pharmacy you'll really use. Our post on insurer-owned pharmacies and Part D cost shows how big that swing can be.
3. Your income. If your income and savings are low enough, Extra Help can cut your premium and copays dramatically, so check your eligibility with Social Security before comparing anything else. At the other end, higher-income beneficiaries pay an IRMAA surcharge on top of the Part D premium, and that's the same on every plan. Either way, income changes which plan wins, and your Medicaid or Medicare Savings Program status can change during the year.
4. Your ZIP code. Plans are sold by region, and many regions have 30 or more standalone Part D plans, plus Medicare Advantage plans with drug coverage. A plan that is cheapest one county over may not be offered to you at all.
If you're weighing a $0-premium plan against one with a premium, our earlier comparison, Eliquis and Jardiance on a $38/month plan vs. a $0-premium plan, shows a second set of numbers with the same pattern.
How I Built These Numbers
Pelandri's data layer holds 12,086 rows across six sources, including 1,080 rows of BLS medical CPI data, 4,080 rows of CMS marketplace plan files, and 30 plan-default rows. Those are ACA and employer-plan datasets, and they help frame the premium and deductible pressure the KFF piece describes. They are not Part D formulary prices. The plan-level figures in this post's tables are modeled by hand from common Part D plan structures using the negotiated prices above. They aren't quotes from a specific plan in a specific ZIP code. Your real plans will have different tiers, deductibles, and copays, which is exactly why the comparison has to be run with your inputs.
Your Pre-December 7 Checklist
- Make your list. Every drug, exact strength, and how many fills per year. Include any drug your doctor might change in the coming year.
- Name your pharmacy. Local, chain, or mail order. Note whether you'd switch for a lower price.
- Read your Annual Notice of Change. It shows what your current plan will charge for each of your drugs next year. Formularies change.
- Check Extra Help and Medicaid status. Confirm it's current, especially if state or federal rules on your coverage are changing.
- Confirm your Medicare eligibility. If you're among those affected by the immigration-related eligibility changes Medicare Rights describes, verify your dates before enrolling.
- Compare total annual cost, not premium. Premium plus deductible plus copays plus coinsurance, for your list.
- Enroll by December 7. Coverage starts January 1. If you do nothing, you're auto-renewed into your current plan, whatever it now costs.
The most common mistake I saw over 20 years of counseling wasn't a bad choice. It was no choice, made by default in December.
Running this by hand takes an hour and a calculator. Pelandri does it for your drug list, pharmacy, and ZIP code, showing the total annual cost of each plan rather than just the premium. Enter your medications before December 7 and see what your version of the $377 gap looks like.
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
- It’s Hard To Predict Who Will Be Suicidal. It’s Easier To Ensure People Can’t Shoot Themselves. — KFF Medicare
- Thousands of Immigrants Scheduled to Lose Medicare Coverage in the New Year — Medicare Rights Center
- Sticker Shock at the Doctor’s Office Could Motivate Midterm Voters — KFF Medicare
- Health Journalists Visit Conservative Georgia District and Weigh AI Bioweapon Threat — KFF Medicare
- Cost-Saving Medicaid Meal Deliveries Threatened by Cuts, Policy Uncertainty — KFF Medicare