Metformin, Atorvastatin, and Eliquis Cost $1,020 on One Part D Plan — and $1,540 on Another: How to Compare Drug Plans Before the March 31 Deadline
Metformin, Atorvastatin, and Eliquis Cost $1,020 on One Part D Plan — and $1,540 on Another: How to Compare Drug Plans Before the March 31 Deadline
You take metformin 1000mg for Type 2 diabetes, atorvastatin 40mg for cholesterol, and Eliquis 5mg twice daily for atrial fibrillation. Three medications. Very common combination. And here's the number that should get your attention: depending on which Part D plan you're enrolled in right now, that same drug list costs anywhere from $1,020 to $1,540 out of pocket in 2026 — before you spend a single dollar on anything else.
That $520 annual gap has nothing to do with your health. It has everything to do with which plan your neighbor recommended in 2023, or which one auto-renewed when you didn't make a change during Open Enrollment.
And here's the deadline you need to know right now: if you're enrolled in a Medicare Advantage plan, you have until March 31, 2026 to make one coverage switch through the Medicare Advantage Open Enrollment Period (MA OEP). That window includes switching to a different MA plan with better drug coverage — or returning to Original Medicare and adding a standalone Part D plan. After March 31, you're locked in until next fall's Open Enrollment unless you qualify for a Special Enrollment Period.
Let's run the actual numbers — drug by drug, plan by plan — so you understand what's at stake.
Why the Premium Is Almost Never the Real Story
Rising health care costs are forcing real decisions for real people, as KFF Health News has documented extensively. But the trap most Medicare beneficiaries fall into isn't picking an expensive plan — it's picking a plan based on the monthly premium and ignoring everything that follows.
Here's how that plays out with the three-drug list above.
A $0-premium plan sounds like a win. But premiums are only one line in the budget. The full picture requires four numbers:
- Annual premium (what you pay every month regardless of drug use)
- Deductible (what you pay before the plan covers anything — up to $590 in 2026)
- Copays and coinsurance (your share after the deductible, determined by the drug's formulary tier)
- Out-of-pocket cap (2026's landmark $2,000 cap means you pay nothing after hitting it)
Once you add all four lines together, a $0-premium plan can cost you $500 more annually than one with a $28/month premium. The reason is almost always the formulary tier assigned to your most expensive drug.
The Worked Example: Three Plans, Same Three Drugs
Let's price out the 2026 annual cost for metformin 1000mg, atorvastatin 40mg, and Eliquis 5mg across three real-world plan structures. Eliquis is now a CMS-negotiated drug under the Inflation Reduction Act, with a 2026 maximum fair price of approximately $231/month. How that price gets passed to you depends entirely on the tier your plan assigns it.
For more on how Eliquis's negotiated price changes your cost math, see our breakdown of Eliquis at the negotiated price across Part D plans.
Plan A — $0 Premium, Tier 3 Eliquis at 25% Coinsurance
| Cost Component | Amount |
|---|---|
| Annual premium | $0 |
| Deductible (applies to Tier 3 Eliquis) | $590 |
| Metformin Tier 1 copay × 12 months | $0 |
| Atorvastatin Tier 1 copay × 12 months | $0 |
| Eliquis coinsurance after deductible (10 months × $58) | $580 |
| Total annual cost | $1,170 |
How the deductible plays out: Eliquis at $231/month means the $590 deductible is consumed by months 1 and 2. Starting month 3, you pay 25% coinsurance — $231 × 25% = approximately $58/month.
Plan B — $0 Premium, Tier 3 Eliquis at $95 Flat Copay
| Cost Component | Amount |
|---|---|
| Annual premium | $0 |
| Deductible | $590 |
| Metformin Tier 1 copay × 12 months | $0 |
| Atorvastatin Tier 1 copay × 12 months | $0 |
| Eliquis flat copay after deductible (10 months × $95) | $950 |
| Total annual cost | $1,540 |
Same $0 premium as Plan A. Same generic drugs. The only difference is how the plan structures the Eliquis copay — and it costs you $370 more per year.
Plan C — $28/Month Premium, Tier 2 Eliquis at $47 Copay, No Deductible
| Cost Component | Amount |
|---|---|
| Annual premium ($28 × 12) | $336 |
| Deductible | $0 (waived for all tiers) |
| Metformin Tier 1 copay × 12 months ($5 × 12) | $60 |
| Atorvastatin Tier 1 copay × 12 months ($5 × 12) | $60 |
| Eliquis Tier 2 copay × 12 months ($47 × 12) | $564 |
| Total annual cost | $1,020 |
Plan C — the one with the monthly premium — costs $520 less per year than Plan B and $150 less than Plan A. That's what happens when a plan places Eliquis on a preferred tier and waives the deductible. The $28/month you're paying covers a significantly cheaper copay structure.
This is the kind of drug-by-drug annual cost modeling that Pelandri runs for you automatically — so you don't have to build the spreadsheet yourself.
How the $2,000 Out-of-Pocket Cap Changes This Calculation
Starting in 2026, Part D has a hard cap: you pay no more than $2,000 in out-of-pocket drug costs per year. This is the biggest structural change to Part D in decades, and it reshapes which plans make sense depending on how expensive your medications are.
For the three-drug list above, none of these plan scenarios hit $2,000 in total out-of-pocket — which means the cap doesn't rescue you from a poor plan choice. You'd pay every dollar of that $1,540 on Plan B with no safety net kicking in.
Where the cap changes the math is when you have a high-cost specialty drug — think Jardiance, Ozempic, or a chemotherapy agent — where coinsurance can run $300-$500/month. In those cases, hitting the $2,000 cap quickly may actually make a high-coinsurance plan cheaper than a flat-copay plan. It's counterintuitive, but the math works out that way.
For a deeper look at how the $2,000 cap works in practice — specifically for Eliquis users — we've laid out the before-and-after mechanics in detail at Medicare's $2,000 Drug Cap Explained.
The Five Variables That Determine YOUR Best Plan
Here's the uncomfortable reality of Part D: there's no single "best plan." There's only the best plan for your drug list, your pharmacy, your ZIP code, and your income. Every one of these variables changes the outcome.
1. Your drug list — including dosage and quantity The same molecule at different doses can land on different tiers. Metformin 500mg and metformin 1000mg extended-release are not always priced identically across plans. Formulary placement is dose-specific.
2. Your pharmacy Plans designate some pharmacies as "preferred" and charge lower copays there. Using a non-preferred pharmacy for Eliquis could cost you $30-$60 more per fill than the preferred network pharmacy — with zero change in the pill itself. Mail-order pharmacies frequently offer the lowest per-fill cost for maintenance drugs but require 90-day supply planning.
3. Your ZIP code Part D plans are regional. The 12 plans available in one ZIP code may be entirely different from the 15 plans available in the next county. Plan Finder results are specific to your location — national plan names mean nothing without the local formulary attached.
4. Your income If your modified adjusted gross income exceeds $106,000 (individual) or $212,000 (joint) in 2026, you pay the Income-Related Monthly Adjustment Amount (IRMAA) on top of your Part D premium. This changes the premium-to-copay break-even analysis. And if you qualify for Extra Help (the Low Income Subsidy), your copays and deductibles are dramatically reduced — sometimes to $0 — and the comparison math changes entirely.
5. Prior authorization and step therapy requirements A plan may list Eliquis on its formulary at a $47 copay, but require prior authorization before covering it. If your cardiologist has already documented why you need Eliquis specifically, that PA clears easily. But if the plan requires you to try a different blood thinner first (step therapy), that's a clinical and administrative barrier worth knowing before you enroll.
You can model these variables for your specific situation at Pelandri — it pulls from CMS formulary data and Medicare Plan Finder results to show you annual cost, not just monthly premium.
The March 31 Deadline: Who It Applies To and What You Can Do
The Medicare Advantage Open Enrollment Period runs January 1 through March 31 each year. According to the Medicare Rights Center, this window allows one coverage change for people already enrolled in an MA plan. That includes switching to a different MA plan — one that may have better drug formulary coverage — or leaving MA entirely to return to Original Medicare with a standalone Part D drug plan.
MA OEP does not allow:
- Switching from Original Medicare to a Medicare Advantage plan
- Enrolling in a standalone Part D plan if you're already on Original Medicare without one
- Making a second MA switch if you've already used the OEP
If you're in an MA plan and your drug costs have been higher than expected — or your drug list changed this year — March 31 is your next real decision point. After that, you're waiting until October 15.
The ACA's protections, now 16 years old as noted by the Medicare Rights Center, reinforced standardized appeals processes and formulary protections that give you real leverage here. You have the right to request a formulary exception if your drug isn't covered or is placed on a higher tier than warranted. But exercising that right requires knowing what the alternatives look like first.
What to Do Before March 31
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Pull your current plan's formulary at Medicare.gov/plan-compare and find which tier each of your drugs sits on. Don't assume it's the same as last year — formularies change annually.
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Build your drug list with exact dosages and quantities. Generic name, brand name, dosage, and how many tablets per month. This is the input that drives the comparison.
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Run the four-line annual cost for at least two alternative plans: deductible + premium + copays × 12 months. Don't stop at the monthly premium.
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Check your preferred pharmacy's network status under each plan you're considering. Preferred vs. non-preferred can swing $400/year on a single brand-name drug.
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Check Extra Help eligibility if your income is limited. The full LIS benefit can reduce your Eliquis copay to $11.20 or less in 2026, which changes every comparison you'd otherwise make.
The Medicare Rights Center has consistently emphasized that beneficiaries should actively evaluate their coverage each year — defaulting to last year's plan is a financial decision, even when it feels like not making one.
The Bottom Line
For the specific drug list above — metformin, atorvastatin, and Eliquis — the plan with the lowest monthly premium costs $520 more per year than the right plan. That gap isn't a rounding error. It's a car payment. It's a utility bill. It's real money that stays in your pocket if you run the actual numbers before March 31.
The comparison isn't hard once you have the right inputs. What's hard is knowing which inputs to gather, which plan documents to read, and how the deductible interacts with tier placement for your specific drugs.
Pelandri was built to handle exactly that — drug by drug, plan by plan, in your ZIP code — so you can walk into March 31 with a number, not a guess.
Sources
- An Arm and a Leg: Steep Health Care Costs Steer Americans to Tough Decisions — KFF Medicare
- Sixteen Years of the Affordable Care Act — Medicare Rights Center
- Demoralized CDC Workforce Reels From Year of Firings, Funding Cuts, and a Shooting — KFF Medicare
- Listen to the Latest ‘KFF Health News Minute’ — KFF Medicare
- The Annual Deadline to Make Certain Medicare Advantage Changes Is Fast Approaching — Medicare Rights Center