Eliquis and Jardiance Cost $1,584 a Year on a $38/Month Part D Plan vs. $1,985 on a $0-Premium Plan: Extra Help, Mail Order, and Tier Exceptions Before December 7

You take Eliquis 5 mg twice a day, Jardiance 10 mg once a day, atorvastatin 40 mg, and metformin 500 mg. Your current Part D plan has a $0 premium, and you have never thought much about it. Then a notice arrives saying the plan's 2027 terms are changing.

Here is what those four drugs cost on two illustrative plans in a single year: $1,985 on the $0-premium plan and $1,584 on a plan that charges $38 a month. The plan that costs more every month costs less over the year. Add the right pharmacy, a mail-order fill, or Extra Help, and the gap gets much wider.

Medicare Open Enrollment runs October 15 to December 7, 2026. It's September 19 as I write this. You have time to do this properly, and this post shows you how.

First, a note on the numbers

Pelandri's data layer has 12,086 rows across six sources: the BLS medical care CPI series, Census ACS 5-year health coverage tables, CMS marketplace public-use files, ACA subsidy parameters, employer plan data, and plan defaults. Those sources track coverage and cost trends. They do not contain Part D plan-level prices for your ZIP code.

So the two plans below are illustrative models built on published Part D design rules and Medicare's negotiated prices. They are not quotes from a real contract. The method is real, and you can rerun it with your own numbers from Medicare Plan Finder once 2027 plan data posts, usually in early October.

What your four drugs cost before insurance touches them

Medicare's negotiated prices took effect in 2026. Two of the drugs in this example are on that list:

Drug	Monthly price used	How the plan charges you
Eliquis 5 mg (60 tablets)	$231	Brand tier: deductible, then coinsurance or copay
Jardiance 10 mg (30 tablets)	$197	Brand tier: deductible, then coinsurance or copay
Atorvastatin 40 mg	Low single digits	Generic tier: flat copay
Metformin 500 mg	Low single digits	Generic tier: flat copay

The two brand drugs total $428 a month, or $5,136 a year. The generics barely register on price, but on some plans their copays add up, as you'll see.

Two 2026 rules matter for the math. The standard Part D deductible is capped at $615. Your annual out-of-pocket maximum is $2,100. In this post, "out-of-pocket" means what you pay at the pharmacy. Medicare's term for the running total that counts toward the cap is TrOOP, short for true out-of-pocket cost. Some of our earlier posts use the round $2,000 figure from 2025. The 2026 cap is $2,100. CMS updates these numbers every year, so confirm the 2027 figures in Plan Finder. Also, the 2027 negotiation round adds 15 more drugs, including Ozempic and Trelegy Ellipta. If you take one, your math changes.

Two plans, one drug list

Plan A has a $0 premium. It charges a $615 deductible on brand tiers, then 25% coinsurance. Generics are $10 per 30-day fill at a standard retail pharmacy.

Plan B costs $38 a month, or $456 a year. It has no deductible. Brand drugs are a flat $47 per 30-day fill, and generics are $0.

Plan A, month by month

January: You pay the full $428 for Eliquis and Jardiance, because you're inside the deductible.
February: You pay the remaining $187 of the deductible, plus 25% of the other $241, which is $60.25. Total: $247.25.
March through December: 25% of $428 is $107 a month. Ten months come to $1,070.

Brand total: $428 + $247.25 + $1,070 = $1,745.25. Add generics at $20 a month, or $240 a year, and Plan A's out-of-pocket cost is $1,985.25. With a $0 premium, that is the whole bill. It is also close to the $2,100 cap. One more brand drug and you'd hit it.

Plan B

Two brands at $47 a month is $94 a month, or $1,128 a year. Generics are $0. Add the $456 premium and the total is $1,584.

	Plan A ($0 premium)	Plan B ($38/month)
Annual premium	$0	$456
Generics (2 drugs)	$240	$0
Eliquis + Jardiance	$1,745	$1,128
Total annual cost	$1,985	$1,584
January cash at the pharmacy	$448	$94 (plus $38 premium)

The difference is $401 a year, and Plan A also hits you hard in January. The Medicare Prescription Payment Plan can spread costs across the year. It doesn't lower the total, though, so it helps cash flow and nothing else.

This is the kind of comparison Pelandri is built to run for you, so you don't have to build the spreadsheet yourself. I built this one by hand for my own scenario, and I still checked it twice.

The break-even: is the premium worth it?

A premium is a bet on how much brand-name medication you take. Here are the results for the same two plans:

No brand drugs (just the two generics): Plan A costs $240 and Plan B costs $456. Plan A wins by $216.
Eliquis alone plus the two generics: Plan A costs about $1,394 and Plan B costs $1,020 ($564 in copays plus the $456 premium). Plan B wins by $374.

For a single brand drug, the tipping point on these two plans is a negotiated price of about $106 a month. Below that, the $0-premium plan wins. Above it, the $38 plan wins. Eliquis at $231 is well above the line. A cheaper brand at $75 a month would sit below it.

This is why "the plan I've always had" is a risky default. Your break-even depends on which drugs are on your list this year. I walked through a similar comparison in Eliquis, Metformin, and Lisinopril: Why a $0-Premium Part D Plan Can Cost $437 More Per Year Than a $33/Month Plan.

Three ways to lower the bill on the plan you pick

1. Preferred pharmacy

Many plans set lower copays at preferred pharmacies. In Plan A, moving the two generics to the preferred pharmacy at $0 removes $240 from the year and drops the total to $1,745. Plan B is still cheaper, by $161, but the gap narrows.

Check the pharmacy network before you decide. Some preferred pharmacies are owned by the insurer, and I've written about how that changes what you pay in Eliquis Costs $2,000 at an Independent Pharmacy vs $3,130 at Your Insurer's Own Pharmacy.

2. Mail order

Some plans price a 90-day mail-order fill at two copays instead of three. Suppose Plan B does. A 90-day fill of each brand costs $94 instead of $141, and you make four fills a year:

Eliquis: 4 × $94 = $376, versus $564 at retail
Jardiance: 4 × $94 = $376, versus $564 at retail
Savings: $376, bringing Plan B to $1,208

Put mail order on Plan B and a preferred pharmacy on Plan A, and the gap grows from $401 to $537. Not every plan offers this discount, so verify it in Plan Finder. Mail order also means a delay if something goes wrong with a shipment, and that matters for a blood thinner. Talk to your prescriber and pharmacist about whether it fits you.

3. Tier exception

Say a plan lists Jardiance on Tier 4, a non-preferred brand tier, at $100 a month. A tier exception asks the plan to charge you the Tier 3 rate instead, $47 in this example. That saves $53 a month, or $636 a year. Here is how it works:

Your prescriber submits a supporting statement, usually explaining why a lower-tier alternative won't work for you.
The plan must decide within 72 hours, or 24 hours if it's expedited.
Plans generally don't grant tier exceptions for specialty-tier drugs.

Choose your plan first, then ask for the exception. I cover the request steps in Eliquis Costs $144/Year With Extra Help vs $2,000 Without It.

You can model these three levers against your own drug list at Pelandri. That is the fastest way to see which of them applies to you.

Extra Help changes the whole picture

Extra Help, also called the Low-Income Subsidy or LIS, is the biggest lever if you qualify. With full Extra Help, the deductible goes away. Copays in 2026 are up to $5.10 for generics and $12.65 for brands, and lower for some people. Partial Extra Help means 15% coinsurance after a reduced deductible. If you choose a benchmark plan, the premium can be fully covered.

Here is the same drug list with full Extra Help:

Eliquis: $12.65 × 12 = $151.80
Jardiance: $12.65 × 12 = $151.80
Atorvastatin and metformin: 2 × $5.10 × 12 = $122.40
Total: $426, with a $0 premium on a benchmark plan

That's $1,559 less than Plan A and $1,158 less than Plan B. For an individual, the income limit is roughly 150% of the federal poverty level, about $23,475 for 2026. There are also resource limits that don't count your home or one car. Apply through the Social Security Administration.

If you already qualify for Extra Help or have Medicaid, you can switch to a standalone Part D plan once a month, not only during Open Enrollment. The Extra Help caregiver guide explains how to help a parent apply.

One practical warning: pharmacy coupons don't count toward the out-of-pocket cap. I explain that in Eliquis at $280/Month on GoodRx vs. $47/Month Through Part D.

What this month's news means for your comparison

I'm not taking a side on any policy debate. I'm pointing out where the news touches the number on your pharmacy receipt.

Medicare eligibility is changing for some immigrants. The Medicare Rights Center reports that thousands of immigrants are scheduled to lose Medicare coverage in the new year under H.R. 1. Medicare Rights has urged CMS to soften the effects in its comments on the proposed rule. Part D goes with Medicare, so someone who loses Medicare also loses Part D and any Extra Help attached to it. If you or a family member may be affected, look for notices, confirm status with Social Security or 1-800-MEDICARE, and ask about your options before you pick a 2027 plan.

Premiums and deductibles are on voters' minds. KFF Health News reports that steep jumps in health insurance premiums and deductibles are top of mind heading into the midterms. For Part D, the deductible is one of the two numbers that decide your January bill. The other is the copay on your two or three most expensive drugs. Those are the two cells to compare first.

Medicaid changes reach Extra Help. KFF Health News also reports that Medicaid meal-delivery programs face uncertainty from budget cuts. If you have Medicaid, your Extra Help status follows it. Check that both are current before you assume a $5 copay.

FDA-ordered studies are overdue. KFF Health News reports that many required postmarket safety and efficacy studies are behind schedule or overdue, and Amgen's Tavneos appears in the reporting. Whether any medicine is right for you is a question for your prescriber, not this post. The Part D angle is narrower. Newer and specialty drugs tend to come with prior authorization and step therapy rules. Check those on every plan you're considering, before you commit.

A 20-minute checklist before December 7

Write down every medication with its dose and pharmacy. Include one-time and seasonal prescriptions.
Enter your list into Plan Finder in early October, using your ZIP code and your real pharmacy.
Compare total annual cost, not premium. Add premium, deductible, and copays for each plan, and note which month you'd reach the cap.
Test the levers. Rerun each plan with the preferred pharmacy and with mail order, and note which drugs sit on a high tier.
Check Extra Help and Medicaid status. If you might qualify, apply now.
Look at prior authorization and step therapy for any brand or specialty drug.
Enroll by December 7. If you do nothing, you stay on last year's plan, and its 2027 terms may not match what you had.

Run it for your own drug list

The $401 gap in this post comes from four drugs and two plans. Your list will produce a different number, and it may run in the opposite direction if you take no brand drugs at all.

Pelandri compares Part D plans by your actual medications, pharmacy, and income, and shows total annual cost instead of just the premium. Try it for your list before Open Enrollment closes on December 7.

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

Thousands of Immigrants Scheduled to Lose Medicare Coverage in the New Year — Medicare Rights Center
Health Journalists Visit Conservative Georgia District and Weigh AI Bioweapon Threat — KFF Medicare
Sticker Shock at the Doctor’s Office Could Motivate Midterm Voters — KFF Medicare
Cost-Saving Medicaid Meal Deliveries Threatened by Cuts, Policy Uncertainty — KFF Medicare
The Drugs and Devices Have Been on the Market for Years. But FDA-Ordered Studies Still Aren’t Done. — KFF Medicare