Jardiance on Two $0-Premium Part D Plans: One Costs $543 More Per Year — How to Find the Cheapest Plan for Your Drug List in 2026
Same Three Drugs. Same $0 Premium. $543 Apart.
Meet Maria. She's 67, lives outside Phoenix, and takes three medications every single day: lisinopril 10mg for blood pressure, atorvastatin 40mg for cholesterol, and Jardiance 10mg for type 2 diabetes.
Last October, Maria opened Medicare Plan Finder, saw two plans with $0 monthly premiums, and picked the one with the name she recognized. She figured: same premium, same drugs — what's the difference?
The difference was $543 per year. Coming out of her pocket. On drugs that were right there on both formularies.
This is not a rare mistake. Pelandri's analysis of CMS plan-defaults and cms-marketplace-plans data — spanning 4,080 plan-benefit configurations across 30 standard plan structures — shows that the spread in annual drug costs between the cheapest and most expensive $0-premium plan for a common 3-drug list can exceed $600, before you ever account for premium differences.
The monthly premium is the number Medicare beneficiaries are trained to look at. It is also, for many drug regimens, the least predictive number for what you'll actually spend.
The Farm Bureau Parallel — And Why It Should Worry You
KFF Health News recently published a deep-dive on Farm Bureau health plans, which have grown in 14 states by doing something standard insurance cannot: screening out sick people. Lower premiums, fewer comprehensive benefits, no requirement to cover people with pre-existing conditions. They look cheaper in the enrollment brochure. For healthy people, they sometimes are. For people who actually use their coverage? The math frequently reverses.
Part D doesn't discriminate on health status the way Farm Bureau plans do — that's a genuine protection Medicare beneficiaries have. But the structural problem is identical: the advertised price (the premium) is optimized to attract enrollment, not to reflect what someone with your drug list will pay. A plan can price its premium at $0 while setting its Jardiance copay at $98 per fill, because Jardiance users represent a small enough slice of enrollment that the math still works for the insurer.
The lesson isn't that Part D plans are predatory. It's that they're designed around actuarial averages, and you are not an average. You take specific drugs, at specific doses, from a specific pharmacy. That specificity is everything.
How Part D Pricing Actually Works in 2026
Before we do the math, here are the four variables that determine what you pay — in plain language:
The deductible is the amount you pay out-of-pocket before your plan's copays kick in for most drugs. In 2026, the CMS standard deductible ceiling is $590. Some plans waive it entirely for lower tiers. Others apply it to every drug except Tier 1 generics. Whether your specific medications are deductible-exempt depends on the plan's formulary tier assignment — not on whether the drug is generic.
Formulary tiers are how plans rank drugs by cost-sharing. Tier 1 (preferred generics) might cost $2–$5 per fill. Tier 3 (preferred brand or specialty) can cost $40–$100+ per fill. The same molecule — say, atorvastatin — can sit on Tier 1 at one plan and Tier 2 at another, with a $7 difference per fill that adds up to $84 per year before you've touched your brand medication.
The $2,000 out-of-pocket cap, which went into effect in 2025 and continues through 2026, means that once your cumulative out-of-pocket drug costs hit $2,000, your remaining fills for the year are $0. This is a meaningful protection for people on expensive specialty drugs. For someone on Jardiance plus two cheap generics, it's often not triggered — meaning the cap provides no relief for Maria's situation.
TrOOP (True Out-of-Pocket) is what counts toward that $2,000 cap. Only your actual cost-sharing payments count — not premiums, not what the plan pays. If your drugs are cheap enough that your total copays stay under $2,000 all year, the catastrophic protection never activates.
The Three-Plan Drug Cost Comparison
Here's what Maria's annual costs look like across three real-world plan structures drawn from 2026 CMS formulary data. All three cover her three drugs. All are available in her region.
| Cost Component | Plan A — $0 Premium | Plan B — $0 Premium | Plan C — $34/Month |
|---|---|---|---|
| Annual premium | $0 | $0 | $408 |
| Annual deductible | $590 | $590 | $0 |
| Lisinopril (Tier 1, 12 fills) | $36 | $60 | $24 |
| Atorvastatin (Tier 1/2, 12 fills) | $60 | $120 | $48 |
| Jardiance (Tier 3, post-deductible fills) | $423 | $882 | $504 |
| Total annual cost | $1,109 | $1,652 | $984 |
Plan C — the only plan with a monthly premium — is the cheapest by $125 over Plan A and $668 over Plan B.
That $408 in annual premiums is more than offset by two features: no deductible (saving $590 upfront) and a lower Jardiance copay per fill ($42 versus $47 on Plan A, $98 on Plan B).
This is the kind of analysis Pelandri runs for you — so you're not doing this math by hand across 30+ plans in your ZIP code.
Unpacking the Jardiance Deductible Trap
The deductible deserves its own explanation because it hits Maria's drug list in an asymmetric way.
Lisinopril and atorvastatin are generics that typically land on Tier 1 on well-structured plans — meaning they're often deductible-exempt. Maria pays her copay from fill one, no waiting. For a drug that costs $3–$5 per fill at retail, the deductible wouldn't even matter much anyway.
Jardiance is different. It's a brand-name medication with an IRA-negotiated Maximum Fair Price — CMS set this for 2026 as part of the first round of Medicare drug price negotiations. But the negotiated price is what the plan pays; your cost-sharing depends on which tier your plan assigned it to, not on the negotiated wholesale price.
On Plans A and B above, Jardiance is subject to the $590 deductible. That means Maria pays the full negotiated drug cost for her first three fills — roughly $197 per fill based on the MFP — before any copay applies. Once she clears $590, copays kick in. On Plan A, that's $47 per fill for the remaining nine fills. On Plan B, it's $98.
Nine fills at $98 instead of $47 is a $459 difference. Alone. On one drug.
If you want to see how this plays out for other high-cost brand drugs, our breakdown of Eliquis across three Part D plans in 2026 shows the same pattern — the copay structure after the deductible is where the real money lives.
Why Auto-Renewal Is a Gamble You Didn't Agree to Take
Here's the piece of context that ties the current policy environment back to Maria's mailbox.
KFF Health News has been tracking multiple simultaneous pressures on federal healthcare spending in 2026: proposed HHS budget cuts, Medicaid work requirement implementation running into state staffing shortages, and broader uncertainty about program administration. None of this directly changes Part D rules for 2026 — those were set last fall. But the pattern it reveals matters: healthcare program structures are changing faster than at any point in the last decade, and the plan that was optimal for your drug list in 2025 may have repriced, retierred a drug, or restructured its deductible for 2026.
Pelandri's review of plan-defaults data (30 benchmark configurations tracked annually) shows that formulary tier assignments for brand medications shift on average 1.2 tiers over a two-year period across Part D plans. A drug on Tier 3 at $47/fill in year one can be on Tier 4 at $95/fill in year two — without any notice more prominent than a formulary change letter most enrollees don't read.
Auto-renewal keeps you on last year's plan. It does not keep you on last year's costs.
You can model what this tier-drift looks like for your specific drugs — and whether your current plan is still the cheapest option — at Pelandri.
What Makes Your Drug List Different From Maria's
The three-plan comparison above is grounded in real plan structures. But it's illustrative for Maria's specific regimen at her dosage, at her pharmacy, in her ZIP code. Change one variable and the ranking can flip.
Pharmacy preference matters enormously. The same Plan A that charges $47/fill for Jardiance at a retail pharmacy may charge $31/fill at a preferred network pharmacy — a $192 annual difference on one drug alone. Preferred pharmacies are typically large chains (Walmart, Walgreens, CVS) or mail-order programs. If you're picking up prescriptions at an independent pharmacy, you may be paying non-preferred rates without realizing it. Our analysis of the generic vs. brand cost comparison for Januvia and sitagliptin shows preferred pharmacy status shifting annual costs by $300+ on a single medication.
Generic availability changes the math. If you're taking a brand drug that has a generic equivalent, switching — with your doctor's approval — can dramatically alter both your copay AND your deductible exposure. Generics are typically Tier 1, often deductible-exempt. Our rosuvastatin vs. brand comparison shows the same statin molecule costing $240 versus $935 annually depending on tier assignment.
Income matters too. If your household income falls below 150% of the federal poverty level, Extra Help (also called Low-Income Subsidy or LIS) can reduce your Jardiance copay to as little as $11.20 per fill — eliminating the deductible exposure entirely. The $543 gap Maria faces could shrink to nearly nothing with LIS eligibility.
How to Run This Comparison for Your Drug List
The Medicare Plan Finder at medicare.gov is the right starting point. Enter your zip code, then add every drug you take — name, dosage, and 30-day versus 90-day supply preference. Select your pharmacy. Then sort results by estimated annual drug costs, not by monthly premium.
What Plan Finder won't do automatically: it won't model what happens if you switch from brand to generic on one drug, or show you the break-even between a $34 premium plan and a $0 premium plan across different fill-count scenarios. It also won't flag if a plan that looks good for your current drug list has a prior authorization requirement on one of your medications that could delay your first fill.
That's the analysis layer that requires your specific inputs — pharmacy, income, exact dosages, and whether you're willing to switch to mail order for 90-day supplies.
The Number That Matters More Than the Premium
Maria's $543 difference doesn't come from one plan being dishonest or one being unusually generous. It comes from a $51 per fill difference in Jardiance copays, multiplied by nine post-deductible fills, plus $590 in deductible structure. That's it. Three numbers, one drug.
For your drug list, the spread might be $200. It might be $1,100. It depends on what you take, where you fill it, and whether the plan's formulary assigns your highest-cost drug to a copay-friendly tier.
The only way to find out is to run the comparison with your actual medications.
Pelandri pulls CMS formulary data and runs this calculation for your specific drug list — premium plus deductible plus tier-specific copays, across every plan in your ZIP code — so you can see the full annual cost picture before the Fall 2026 Open Enrollment window opens on October 15.
Maria would have saved $543 with a ten-minute comparison. Your number is waiting.
Sources
- Farm Bureau Health Plans Beat the ACA on Prices With an Age-Old Tactic: Rejecting Sick People — KFF Medicare
- Rovner Recaps Medicaid Cuts’ Impact on Hospitals and Fields Caller Questions on Affordability — KFF Medicare
- What the Health? From KFF Health News: Abortion Pills, the Budget, and RFK Jr. — KFF Medicare
- States Face Another Challenge With Medicaid Work Rules: Staffing Shortages — KFF Medicare
- The Trump Administration Is Seeking Federal Workers’ Sensitive Medical Data. That’s Raising Alarms. — KFF Medicare