Entresto, Eliquis, and Jardiance Together Cost $11,400 a Year: How Medicare's $2,000 Cap Decides What You Actually Pay in 2026
The Phone Call Every Sandwich-Generation Caregiver Dreads
If you've ever sat at your parent's kitchen table with a shoebox of pharmacy receipts while your own kid texts you about homework, you know the feeling KFF Health News captured in its recent HealthQ Special: Caregiving in the Sandwich Generation — the exhausting math of managing two households' worth of medical decisions at once. For a lot of adult children, one of those decisions is quietly enormous and almost always deferred: is Mom or Dad still on the right Part D plan?
Here's a real scenario. Your mother takes Entresto 24/26mg twice daily for heart failure, Eliquis 5mg twice daily to prevent stroke, and Jardiance 10mg once daily for diabetes and heart failure protection. This is one of the most common three-drug combinations among Medicare beneficiaries over 70, and based on Pelandri's analysis of formulary and pricing data, it's also one of the clearest examples of how the 2026 Part D benefit design actually works — and where two plans that look similar on paper produce a $280 difference in what she pays out of pocket.
The Donut Hole Is Gone. Here's What Replaced It.
For years, "the donut hole" was the term everyone used for the coverage gap — that stretch after your drug costs crossed a threshold where you suddenly paid a much bigger share. As of the Inflation Reduction Act's Part D redesign, that gap no longer exists in its old form. Instead, every standard Part D plan now has three phases:
- Deductible phase — you pay 100% of your drug costs, up to the plan's deductible.
- Initial coverage phase — you pay coinsurance or a copay (per your plan's formulary tier), and this continues until your true out-of-pocket costs (TrOOP) hit $2,000 for the calendar year.
- Catastrophic phase — once TrOOP hits $2,000, you pay $0 for covered drugs for the rest of the year.
That $2,000 figure is the number that matters most, and it's the same across every standard Part D plan nationwide — no more calculating where the donut hole starts and ends drug by drug. What still varies enormously from plan to plan is the deductible amount, the coinsurance or copay structure during the initial coverage phase, and the monthly premium. Those three levers are what create the cost differences you'll see below. We walked through a similar mechanic with a two-drug list in $9,996 Drug Bill, $2,000 Out-of-Pocket Cap: What Eliquis and Entresto Users Actually Pay; adding Jardiance to the mix changes the timing math in a way worth walking through carefully.
Your Mother's Drug List: The Real Numbers
Based on 2026 formulary and ingredient-cost data, here's what these three drugs cost before any Part D plan's cost-sharing is applied:
| Drug | Dose | Monthly Cost (plan-allowed) | Annual Cost |
|---|---|---|---|
| Entresto | 24/26mg twice daily | $605 | $7,260 |
| Eliquis | 5mg twice daily | $231 (IRA negotiated price) | $2,772 |
| Jardiance | 10mg once daily | $115 | $1,380 |
| Total | $951/month | $11,412/year |
That $11,412 is the total the drug costs your mother's insurance company — not what she pays. What she actually pays depends entirely on which plan she's enrolled in. This is exactly the kind of analysis Pelandri runs for you automatically — so you're not reverse-engineering a formulary PDF at 11pm after the kids are in bed.
Two Plans, Same Drugs, Very Different Math
Plan A — "LowPremium Rx Saver": $0/month premium, $610 deductible (the 2026 standard), 25% coinsurance during the initial coverage phase.
Plan B — "BrandSaver Rx": $75/month premium ($900/year), $0 deductible, flat tier copays — Eliquis $10/month, Jardiance $10/month, Entresto (non-preferred brand tier) $95/month.
Plan A math
- Month 1: her drugs cost $951. The first $610 is 100% her responsibility (deductible). The remaining $341 is charged at 25% coinsurance = $85.25. Total month 1 out-of-pocket: $695.25.
- Remaining room before she hits the $2,000 catastrophic threshold: $2,000 − $695.25 = $1,304.75.
- From month 2 onward, she's paying 25% coinsurance on $951/month = $237.75/month.
- $1,304.75 ÷ $237.75 ≈ 5.5 months.
That means by roughly month 7 of the plan year, she crosses into the catastrophic phase — and pays $0 for Entresto, Eliquis, and Jardiance for the remaining five-plus months.
Plan A total annual cost: $2,000 (deductible + coinsurance, capped) + $0 premium = $2,000/year
Plan B math
- No deductible, so copays start immediately: $10 + $10 + $95 = $115/month.
- $115 × 12 = $1,380/year in copays, none of which is enough, on its own, to push her cumulative TrOOP to $2,000 by year's end.
- Because she never crosses the catastrophic threshold, she pays the full copay amount every single month, all twelve months.
Plan B total annual cost: $900 premium + $1,380 copays = $2,280/year
The comparison
| Plan A | Plan B | |
|---|---|---|
| Premium | $0/year | $900/year |
| Deductible | $610 | $0 |
| Cost-sharing structure | 25% coinsurance | Flat tier copays |
| Reaches catastrophic phase? | Yes, ~month 7 | No — never |
| Total annual cost | $2,000 | $2,280 |
Plan A — the one with the scarier-looking deductible — actually saves your mother $280 a year because it gets her to the $2,000 catastrophic cliff and then stops charging her entirely. Plan B's lower monthly copays feel gentler, but she's paying that amount every month with no finish line, plus a premium on top.
Why Premium Becomes the Real Deciding Factor for High-Cost Drug Lists
Here's the insight that a lot of Medicare beneficiaries and their adult children miss: once your total annual drug costs comfortably exceed roughly $6,000 to $6,500 in plan-allowed charges (as this drug combination does, at $11,412), almost every standard Part D plan will cap your out-of-pocket spending near $2,000 — because the redesign guarantees it. The real differentiator stops being "which plan has the lowest copay for Entresto" and becomes:
- How fast does the plan get you to $2,000? A plan with a front-loaded deductible often gets you into the $0 catastrophic phase sooner than a plan with low flat copays that never accumulate fast enough.
- What's the premium? If two plans both land you at or near the $2,000 cap, the plan with the lower premium wins, full stop.
- Does the plan's tier placement of your specific drugs even trigger the coinsurance math correctly? A drug placed on a "specialty tier" with a percentage coinsurance behaves very differently than one on a flat-copay non-preferred brand tier.
This mirrors a finding MedPAC staff presented at the 2026 AcademyHealth Annual Research Meeting: since the $2,000 cap took effect, catastrophic-phase spending has become the fastest-growing share of total Part D program costs, because plan sponsors now carry more financial risk above the cap than below it. That shift is quietly changing which drugs plans place on which tiers — which is exactly why a formulary that looked fine last November can look different this year. We covered a related dynamic for a different three-drug combination in Eliquis, Metformin, and Lisinopril: Why a $0-Premium Part D Plan Can Cost $437 More Per Year.
The Caregiving Reality Behind the Spreadsheet
The reason this math matters so much to sandwich-generation caregivers specifically: affordability of prescription drugs and health coverage has consistently ranked as a top financial stressor for American families in KFF's polling — including in states like Nevada, where healthcare affordability has become a defining issue in recent elections regardless of party. Families aren't debating policy in the abstract; they're debating whether Mom's Entresto refill fits in this month's budget. When you're the one managing a parent's pills, your own kids' schedules, and possibly your own Medicare decisions down the road, a $280-per-year difference on one drug list — multiplied across a household managing multiple people's prescriptions — adds up to real money and real stress reduction.
If your parent (or you) is on Extra Help / Low-Income Subsidy, this entire calculation changes dramatically — we've broken down exactly how in Eliquis, Metformin, and Atorvastatin: Extra Help, Preferred Pharmacies, and Tier Exceptions, and it's worth checking eligibility before you even start comparing plan premiums.
What To Actually Do Before Open Enrollment Closes
Don't take last year's plan for granted, and don't assume the $0-premium plan or the lowest-copay plan is automatically the cheapest one for your specific drug list. The math above shows two plans landing within $280 of each other for identical drugs — but plenty of real-world plan pairs in a single ZIP code diverge by $500 to $1,000 or more, especially when formulary tier placement differs or one plan requires prior authorization that delays your prescription fills.
You can model this exact deductible-versus-coinsurance-versus-copay math for your own or your parent's medication list, dosages, and ZIP code at Pelandri — instead of building the month-by-month TrOOP spreadsheet by hand between caregiving shifts. Enter the exact drugs, doses, and pharmacy preference, and see the full-year total across every available plan, not just the premium on the front page of Medicare Plan Finder. With a seven-week enrollment window and a drug list this common, it's worth the ten minutes before the deadline closes.
Sources
- HealthQ Special: Caregiving in the Sandwich Generation — KFF Medicare
- New Disease Threats Follow Trump Administration’s Health Program Cuts — KFF Medicare
- Affordable Healthcare Emerges as a Voter Priority in Purple Nevada — KFF Medicare
- Presentations by MedPAC staff at the 2026 AcademyHealth Annual Research Meeting and the 2026 Annual Conference of the American Society of Health Economists — MedPAC
- A Mom Said Infant Formula Killed Her Baby. The Manufacturer Closed the File. — KFF Medicare