Medicare Part D changes take effect January 1, capping out-of-pocket costs and reshaping formulary tiers

Key provisions of the Medicare Prescription Drug Price Negotiation Program lock in on January 1, 2027. Changes include a hard out-of-pocket cap for Part D beneficiaries and new incentives for plans to prefer negotiated drugs on formulary tiers. Practices should review their Medicare patient panels for those on high-cost specialty medications; expect increased prior authorization scrutiny for non-preferred agents as plans realign. Update patient financial counseling scripts by December to explain the new cap and potential tier shifts.