Medicare Drug Savings Eclipsed by Part B Premiums, COLA Challenges and ACA’s Rising Costs

Published in RINewsToday on January 5, 2026

The official arrival of the New Year was marked by millions of viewers channel surfing between ABC, CBS, NBC, and CNN, eager to watch the ball drop in Times Square and ring in 2026. The iconic New York City ball—12,000 pounds and adorned with 5,280 Waterford Crystal discs and LED lights—descended a 139-foot flagpole atop One Times Square. In just 60 seconds, it reached the bottom at midnight on New Year’s Eve, signaling the beginning of 2026.

Just two days before January 1—when Medicare-negotiated prices for 10 prescription drugs take effect—AARP Executive Vice President and Chief Advocacy & Engagement Officer, Nancy LeaMond, shared good news. As the clock struck midnight, she announced that older Americans would see lower prices for the first 10 Medicare-negotiated drugs, which would take effect on January 1, 2026. AARP quickly issued a statement, celebrating the first-ever Medicare-negotiated drug prices and estimating a whopping 50% reduction in out-of-pocket costs for beneficiaries.

“For millions of older Americans managing chronic conditions, prescription drugs are not optional—they are a lifeline. But medicine doesn’t work if people can’t afford it,” said LeaMond in a Dec. 29 statement. She emphasized that AARP has been at the forefront of advocating for drug pricing reforms since 2022. The nation’s largest aging advocacy group, representing nearly 38 million members, shared their stories, conducted national research on drug costs, and urged lawmakers on both sides of the aisle to support legislative efforts to lower drug costs.

According to LeaMond, this advocacy has delivered significant progress. On January 1, negotiated prices will take effect for the first time, marking a major milestone for both patients and taxpayers. “Older Americans will see real results and billions in savings as the first Medicare-negotiated prices take effect,” she stated, pledging that “AARP won’t stop fighting to lower drug prices until every American can get the medications they need at a price they can afford.”

“These drugs are used by nearly 9 million Medicare beneficiaries and treat conditions such as diabetes, heart disease, autoimmune disorders, and cancer,” she noted.

While Medicare beneficiaries are set to see substantial savings, the Centers for Medicare and Medicaid Services (CMS) anticipates that the Medicare drug price negotiation program will save billions. CMS, a federal agency providing health coverage to over 160 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Marketplace, expects the program to save enrollees roughly $1.5 billion in out-of-pocket costs in 2026 while saving the Medicare program $6 billion per year.  The negotiated prices are a minimum of 38% off the 2023 list price.

On the Other Hand

Though Medicare beneficiaries will benefit from lower out-of-pocket costs on 10 Medicare-negotiated drugs in the new year, the 2026 Social Security COLAs will barely cover Medicare Part B premiums and rising inflation.  Meanwhile, older Americans who are not eligible for Medicare coverage will face soaring health insurance premiums due to the Senate’s failure to extend the Affordable Care Act (ACA) Tax Credits.

Max Richtman, President and CEO of the National Committee to Preserve Social Security & Medicare, stressed the importance of ACA marketplace coverage for older adults, who often struggle to find affordable health insurance. “It’s not only cruel to let their premiums skyrocket; it costs everyone in the long run,” observes Richtman. “Older patients without insurance will be forced to use emergency rooms for care, which drives up costs for all healthcare consumers,” he says in a statement released on Dec. 11, 2026.

“They’ll also arrive at Medicare sicker or more disabled, which not only costs taxpayers more but raises premiums for all older Americans on Medicare,” warns Richtman.

Richtman pointed out that 40% of ACA enrollees are between the ages of 45 and 64. Without the extended tax credits, many of these individuals—including farmers, ranchers, entrepreneurs, and small business owners—will face unaffordable premium increases and may be forced to drop or downgrade their health care coverage. “Extending these tax credits to prevent premium hikes would have made simple common sense,” Richtman argued. “Why would Senators vote to push people off health insurance instead of widening the safety net when the ACA is so clearly beneficial, especially for older, vulnerable enrollees?,” he asked.

Additionally, this year’s premium increase for the standard Medicare Part B program, while not as high as originally projected, will still affect beneficiaries, too. They will face an increase of nearly $18 per month, marking roughly a 10% hike in 2026. In a statement on Nov. 17, 2025, Richtman said that this rise basically cancels out one-third of the average beneficiary’s cost-of-living adjustment (COLA) for 2026.

The standard Part B premium for 2026 will be $ 202.90 a month, which is $17.90 more than last year’s $ 186.  The average COLA will be $ 56 a month in 2026. After accounting for the $18 Part B premium increase, the average Social Security beneficiary will be left with an effective monthly increase of only $36 next year, notes Richtman.

Richtman pointed out that the 2.8% COLA for 2026, announced in October, was already modest before the Medicare premium hike. “In this economy, an extra $36 per month will provide only marginal relief for Social Security beneficiaries,” he said, stressing that seniors with below-average benefits will see even less of a benefit increase once Medicare Part B premiums are deducted.

“Some in lower-income brackets may experience an effective COLA of zero,” predicts Richtman.

A Final Note…

Yes, Medicare beneficiaries will see a decrease in Medicare-negotiated prices for 10 prescription drugs that took effect last week.  But, with inflation rising and older adults struggling to afford basic needs such as food, rent, utilities, and healthcare costs, aging advocates urge Congress to  take action to mitigate the negative impacts of HR 1, the 2025 budget reconciliation bill, on the Medicare drug price negotiation program.  It’s also crucial that Social Security COLAs accurately reflect the out-of-pocket expenses faced by beneficiaries, they say.

“Unfortunately, the 2025 budget reconciliation bill—HR 1—further limits the drugs that can be negotiated under the IRA’s negotiation program, reducing its effectiveness,” warns Julie Carter of the Medicare Rights Center in an October 9, 2025, blog post for Medicare Watch. “KFF, an independent health policy and research organization, estimates that this change will increase Medicare spending by at least $5 billion. As always, increases in Medicare spending lead to higher out-of-pocket costs for beneficiaries,” she says.

“At Medicare Rights, we strongly oppose efforts to scale back the IRA’s negotiation framework. We believe more drugs should be subject to negotiation, not fewer. We also advocate for expanding other cost-saving aspects of the law to reduce expenses for those covered by other forms of insurance,” Carter adds.

“Social Security COLAs are meant to offset the impact of inflation on beneficiaries. However, they are clearly insufficient for many seniors living on fixed incomes,” argues NCPSSM’s Richtman. He explains that this is why his organization has been pushing for an improved COLA formula—the CPI-E (Consumer Price Index for the Elderly). The CPI-E would more accurately reflect the inflationary effects on the goods and services seniors rely on, he says.

“We support legislation that would adopt the CPI-E for determining COLAs, but Congress has yet to take action. Adopting this formula would be a reasonable step toward expanding benefits and truly meeting the needs of 21st-century seniors,” Richtman concludes.

Medicare Enrolled will see Lower Costs on Select Drugs in 2026

Published in Blackstone Valley Call & Times on December 2, 2025

With Medicare Open Enrollment ending next week, the Centers for Medicare & Medicaid Services (CMS) has announced that last year’s Medicare negotiations produced a net savings of 44%—about $12 billion—on 15 widely used prescription drugs that treat cancer and other serious chronic conditions.

The new Maximum Fair Prices (MFPs) for these 15 drugs will take effect on January 1, 2027. Combined with the 10 drugs already negotiated—whose MFPs take effect January 1, 2026—a total of 25 drugs will have negotiated lower prices. These medications, used to treat conditions such as cancer, diabetes, asthma, and cardiovascular and neurological disorders, represent some of the highest Medicare Part D spending.

The Beginning of Drug Price Negotiations

Three years ago, after President Biden signed the Inflation Reduction Act (IRA) in August 2022, CMS began developing the process for Medicare’s first-ever drug price negotiations. On March 15, 2023, the federal agency issued its initial program guidance and received more than 7,500 public comments from consumer groups, patient advocates, drug manufacturers, and pharmacies. Revised guidance followed on June 30, 2023.

On August 29, 2023, CMS released the first list of 10 high-cost drugs selected for negotiation—marking the first time in Medicare’s history that it could negotiate directly with pharmaceutical companies.

Pharmaceutical industry groups and several companies attempted to block the law in court. In response, 70 organizations and 150,000 petition signers urged Merck, Bristol Myers Squibb, Janssen Pharmaceuticals, Astellas Pharma US, the Pharmaceutical Research and Manufacturers of America (PhRMA), and the U.S. Chamber of Commerce to drop their lawsuits. Multiple organizations also filed amicus briefs supporting the law.

Three years in process, and with courts ultimately allowing the program to proceed, that first round of 10 drugs with negotiated prices will take effect in 2026.

CMS Drug Negotiations Added 15 Drugs

On January 17th, CMS announced it had selected 15 additional drugs for the second cycle of negotiations under Medicare Part D and on November 25th, it was announced that agreements had been reached on all of them. These medications are among the most costly and most commonly used by Medicare beneficiaries, treating conditions such as cancer, diabetes, and asthma. The new round of negotiations is expected to save Medicare billions and strengthen the program’s long-term sustainability.

“This year’s results stand in stark contrast to last year’s,” said CMS Administrator Mehmet OzMD, in announcing the second cycle of negotiations.  “Using the same process with a bolder direction, we have achieved substantially better outcomes for taxpayers and seniors in the Medicare Part D program — not the modest or even counterproductive ‘deals’ we saw before.”

“Whether through the Inflation Reduction Act or President Trump’s Most Favored Nation policy, this is what serious, fair, and disciplined negotiation looks like,” adds CMS Deputy Administrator and Medicare Director Chris Klomp. “I’m deeply proud of our team, who execute exceptionally well to bring affordability to the country in everything we do.”

Between January 1 and December 31, 2024, approximately 5.3 million Medicare Part D enrollees used one or more of these 15 drugs. Total gross Part D spending for them was $42.5 billion, representing about 15% of all Part D drug costs.

Anthony Wright, executive director of Families USA, praised the newly released negotiated prices, stating that they show what is possible when “policymakers put patients before corporate profits.” Wright emphasized that these reductions build on the work of establishing the Drug Price Negotiation Program, which aims to provide financial relief to older adults and people with disabilities.

Wright noted that the first and second rounds of negotiated drugs together account for about one-third of Medicare Part D spending, with price reductions ranging from 38% to 85%. In 2027, beneficiaries using these drugs are projected to save $685 million in out-of-pocket costs. He added that the savings support both individual beneficiaries and the long-term sustainability of the Medicare program.

Despite pharmaceutical companies’ continued attempts to limit the program—through lawsuits and legislative provisions such as those in H.R. 1—Wright said the negotiation program remains “the most effective tool currently available to lower drug prices.”

“The Medicare Negotiation Program changed the trajectory of drug pricing in the United States, helping to reduce Big Pharma’s monopoly pricing power, which dictated prices to Americans on Medicare for two decades,” said Merith Basey, executive director of Patients for Affordable Drugs in a statement. “This second round of negotiations — now under President Trump — marks another major milestone, delivering continued savings for patients and taxpayers,” he said.

“The lower negotiated prices are more than numbers on a page. For patients who’ve been forced to work multiple jobs, cut pills in half, or choose between filling a prescription and buying groceries, these lower prices will bring long-overdue relief, flexibility, and stability,” added Basey.

“The requirement that Medicare negotiate lower prices for prescription drugs continues to pay dividends for older Americans and taxpayers,” adds Richard Fiesta, executive director of the Alliance for Retired Americans. “The announcement of lower drug prices for 15 high-priced drugs is a win for more than 5 million seniors who take these drugs to treat asthma, diabetes, lung disease and other serious conditions, and will soon pay less for their medications,” he says.

“The 4.4 million members of the Alliance are pleased that the Trump Administration has followed the law, negotiated these prices, and defended this law in court,” Fiesta says, calling on Congress to increase the number of drugs subject to price negotiations.

While the White House along with aging groups praise the impact of IRA’s Medicare drug negotiation provisions, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued a statement calling it “flawed.”

“Whether it is the IRA or MFN, government price setting for medicines is the wrong policy for America. Price setting does nothing to rein in PBMs who decide which medicines are covered and what patients pay. In fact, many patients are facing additional coverage barriers and paying more out-of-pocket for medicines because of the IRA, warns Alex Schriver, Senior Vice President of Public Affairs.

“These flawed policies also threaten future medical innovation by siphoning $300 billion from biopharmaceutical research, undermining the American economy and our ability to compete globally,” states Schriver, noting that PhRMA members are stepping up to make medicines more affordable by enabling direct purchase at lower prices and investing in U.S. manufacturing and infrastructure.

Lower Drug Cost Legislation Introduced

Congressman John B. Larson (D-CT), a senior member of the House Ways and Means Committee, praised the latest CMS announcement, estimating that both negotiation rounds will save older Americans more than $2 billion per year in out-of-pocket costs. Larson noted that families and seniors continue to struggle with rising prices, especially for prescription drugs.  The lawmaker pushed to enable Medicare to negotiate drug prices to lower drug costs by the enactment of IRA.

Last week, House Democrats introduced the Lower Drug Costs for American Families Act, aimed at closing loopholes in H.R. 1 and further reducing prescription drug prices. The bill (H.R. 6166), introduced November 20 by Ranking Members Frank Pallone Jr. (Energy and Commerce), Richard Neal (Ways and Means), and Bobby Scott (Education and Workforce), has been referred to all three committees.

Key provisions of the bill would:

  • Extend Medicare’s price negotiation authority to all Americans with private insurance—covering more than 164 million people with employer-sponsored plans and over 24 million enrolled in Affordable Care Act plans
  • Apply inflation-based rebate protections to private insurance markets, potentially saving $40 billion over 10 years
  • Increase the number of negotiated drugs from 20 to 50 per year
  • Extend the $2,000 annual out-of-pocket prescription drug cap to privately insured patients
  • Cap insulin costs at $35 per month for those with private insurance
  • Close the orphan-drug loophole that allows companies to avoid negotiation
  • Require consideration of international drug prices to ensure Americans do not pay three to five times more than patients in other countries

Continue the Momentum

According to CMS, the agency will announce the specifics on 15 drugs for the third round of Medicare price negotiations by February 1, 2026. This new round will include drugs paid under Medicare Part B for the first time and will begin with negotiated prices effective January 1, 2028. CMS has already released final guidance for the program and will also use this process to select drugs for renegotiation in previous cycles. IRA also establishes an ongoing process where more drugs will be selected for negotiation in subsequent years.

A Dec. 2024 AARP survey found that almost 3 in 5 adults age 50 and older expressed concern about their ability to afford prescriptions over the near future.  Respondents included both Medicare beneficiaries and younger persons. About 96 percent of the respondents call on the government to do more to lower pharmaceutical prices.

AARP noted that this survey was taken right before a new $2,000 cap on out-of-pocket drug expenses took effect in 2025.

With the announcement of lower drug costs that result from Medicare’s round 2 drug negotiations, there is an  opportunity to build on this momentum for real change. Lawmakers can legislate to put the public’s health above profit by giving consumers more power to negotiate, making competition stronger, and keeping patients from having to pay too much out of pocket.

It is now time for Congress to act.

The ABCs of Surviving Medicare Open Enrollment 

Published in RINewsToday on October 20, 2025

It’s that time. The Medicare Open Enrollment period began last week and runs until December 7th. During this period, Rhode Island’s 243,000 Medicare beneficiaries (data from late 2024 to early 2025) are encouraged to explore their Medicare options, carefully review, compare options, and make necessary changes to their existing Medicare plan for the following year.

During the Medicare Open Enrollment period, you can join a new Medicare Advantage plan or Part D prescription drug plan, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage to Original Medicare (with or without a Part D plan).

You can make as many changes as you want during this period. The last change you ultimately make will take effect on January 1, 2026.

Medicare Options

According to Healthinsurance.org, an independent website that provides consumer information and education on health insurance options, here’s a snapshot of Medicare plans chosen by Rhode Island beneficiaries.

As of September 2024, 144,610 Rhode Islanders were enrolled in Medicare Advantage plans. These plans, offered by private health insurance companies, are alternatives to Original Medicare. Medicare Advantage plans cover all the healthcare benefits that Original Medicare covers (e.g., hospital services and outpatient/medical/physician services), but the out-of-pocket costs can differ significantly, as Advantage plans set their own co-pays, co-insurance, and deductibles (within parameters defined by CMS).

Approximately 115,000 to 120,000 Rhode Islanders are enrolled in Original Medicare, representing about 49-51% of the state’s Medicare beneficiaries. Original Medicare, covering individuals aged 65 and older as well as certain younger people with disabilities, is a “fee-for-service” plan composed of two main parts: Part A for hospital insurance (covering inpatient hospital care, skilled nursing care, hospice care, and some home health services) and Part B for medical insurance (covering doctor visits, preventive care, and durable medical equipment). These two parts cover a wide range of medically necessary services, with beneficiaries paying a portion of costs, such as coinsurance and deductibles.

Medicare Part D is an optional prescription drug benefit offered by private insurance companies approved by Medicare. This benefit helps cover the cost of outpatient prescription medications. Approximately 83% of the total 243,377 beneficiaries in September 2024 have some form of prescription drug coverage through a Medicare Part D plan.

Finally, according to the U.S. Centers for Medicare & Medicaid Services, as of 2024, more than 50,000 Medicare beneficiaries in Rhode Island had Medigap policies. These policies are standardized supplemental insurance plans sold by private companies to cover the “gaps” in Original Medicare (Part A and Part B), including deductibles, co-payments, and co-insurance.

Taking a Close Look at Your Current Coverage

Even if you’re satisfied with your current coverage, the state’s Office for Healthy Aging recommends that Medicare beneficiaries closely review and compare their Medicare options to ensure their needs are met in the upcoming year. “Medicare beneficiaries will receive a lot of mail during Medicare Open Enrollment so it is very important to pay attention to any changes in the plan’s costs, including premiums, deductibles, and cost-sharing amounts. Make sure your providers and pharmacies are still in the plan’s network.”

All Medicare beneficiaries (or those approaching Medicare eligibility) can receive free, unbiased counseling from State Health Insurance Assistance Program (SHIP) counselors. These services are voluntary and meant to help people understand the complexity of plans and make informed choices. SHIP counseling is an offered resource, not a condition of having Medicare or enrolling in a plan.

What to Bring to Your SHIP Appointment

You can enroll in Medicare plans or manage your coverage without using OHA or SHIP partners’ counseling.  There is a risk of not choosing the best plan to meet your medical needs, missing savings or subsidies, and increasing stress or confusion in making the right choice.

After making an appointment, a SHIP counselor will request the beneficiary bring their Medicare card, current plan(s) cards, and a list of prescriptions and doctors to the meeting.

The OHA and its nine partners (see box below) are provided with training, certifications, and resources through the federal SHIP grant ensuring they stay up to date on what every Medicare Advantage, Traditional Medicare, and Medicare Part D plan offers.

Every October, OHA and its SHIP partners meet with presenters from Rhode Island’s Medicare Advantage plans to become aware of updates on all the 2026 plan changes.

Changes in 2026

According to AARP, expect some significant changes in 2026. The first Medicare-negotiated drug prices will go into effect for drugs like Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp. Additionally, according to CMS, savings are expected to lower enrollees’ out-of-pocket spending by an estimated $1.5 billion next year. Finally, the new cap on annual out-of-pocket expenses for Part D drugs will increase to $2,100.

You can call 1-800-MEDICARE to make changes by phone. You can also use Medicare’s Plan Finder tool to compare plans at www.medicare.gov/plan-compare to compare options and enroll in some plans online. Alternatively, you can contact plans directly to enroll.

Find a Medicare plan

However, the Office of Healthy Aging cautions, “Unfortunately, we are still waiting for CMS to release some of the 2026 cost and premium changes, and due to the government shutdown, this may be further delayed.”

A Final Note… Beware of Scams and Fraud

Open Enrollment is also prime time for scams. Scammers who claim to represent Medicare may call asking for your Medicare number, Social Security number, or bank information, especially before you enroll. Medicare will never call, email, or text out of the blue to ask for personal information or payment. If you’re unsure, hang up and call 1-800-MEDICARE to verify.

To schedule an appointment with a State Health Insurance Assistance Program (SHIP) Counselor please contact one of the below agencies.

PARTNER AGENCYLOCATIONPHONE NUMBER
Aging Well84 Social St, Woonsocket, RI 02895401-766-3734
Johnston Senior Center1291 Hartford Ave, Johnston, RI 02919401-944-3343
Westbay Community Action Agency487 Jefferson Blvd, Warwick, RI 02886401-921-5237
South Kingstown Senior Center25 St Dominic Rd, Wakefield, RI 02879401-789-0268
Westerly Senior Center39 State St, Westerly, RI 02891401-596-2404
The Aging & Disability Resource Center (ADRC)50 Valley St, Providence, RI 02909401-462-4444
East Bay Community Action Agency100 Bullocks Point Ave, East Providence, RI 02915401-435-7876
Leon Mathieu Senior Center420 Main St, Pawtucket, RI 02860401-728-7582
Progreso Latino626 Broad St, Central Falls, RI 02863401-728-5920
Edward King House35 King St, Newport, RI 02840401-846-7426

Source:  OHA, Oct. 2025