Medicare Part D Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026

CMS has just released information about Medicare Part D plans for 2026, including plan availability and premiums for the coming year. As this year’s Medicare open enrollment period approaches, there’s some good news for Medicare Part D enrollees when it comes to monthly PDP premiums – lower on average, according to CMS – even as the total number of PDPs available drops yet again.

The headline of CMS’s press release emphasized stability in the Part D marketplace, but a quick review of the data shows that the total number of stand-alone drug plans available in 2026 will fall for the third year in a row, as plan sponsors scale back their PDP offerings (for example, Centene is discontinuing one of the 3 Wellcare PDP options; Health Care Service Corporation is discontinuing one of the 3 Cigna PDP options and withdrawing from several PDP regions) or exit the market entirely (as in the case of Elevance’s Anthem PDPs). Overall, there will be fewer PDPs in 2026 than in 2025 – 360 plans nationwide, down from 464 in 2025.

Firm decisions to exit the PDP market or scale back their PDP offerings in recent years have been based on evaluations about the profitability and viability of the stand-alone drug plan market, particularly for insurers with a smaller footprint, accounting for higher costs associated with a redesigned Part D benefit under the Inflation Reduction Act. The law added an out-of-pocket spending cap for Part D enrollees beginning in 2025 and shifted more of the share of high-drug cost enrollees from the federal government to the plans themselves, which increased plan liability overall. In addition, many insurers that offer both PDP and MA-PD plans have stated their interest in focusing resources on more lucrative Medicare Advantage markets.

Somewhat more unexpected than the reduction in plan availability for 2026 are the year-over-year premium changes for PDPs. A comprehensive KFF analysis will follow in the future, but it appears that substantial premium increases for PDPs across the board didn’t materialize, even as the Trump administration scaled back the level of support for additional PDP premium subsidies through the temporary Part D premium stabilization demonstration established by the Biden administration in 2024. For 2026, the federal government is providing participating PDPs with an across-the-board monthly premium subsidy of up to $10 (down from $15 in 2025) and limiting the monthly premium increase for 2026 to $50 (up from $35 in 2025) – revised parameters which, when they were announced, seemed to point in the direction of higher premiums for PDP coverage in 2026.

In fact, for all but one of the 10 PDPs that were offered nationwide in 2025 and that will continue to be offered on a national or near-national basis in 2026, Medicare Part D enrollees in a number of states will see lower monthly premiums in 2026 than in 2025. This is consistent with CMS’s projection that the average monthly PDP premium will decrease by a few dollars in 2026. Only a few national PDPs are increasing monthly premiums by $50, the maximum allowed under the premium stabilization demonstration, and PDP enrollees may have up to 6 PDPs available for $0 premium, depending on where they live.

Looking at premium changes for a few of the more popular plans shows a mixed picture, however, with wide variation in monthly premiums across plans and the 50 states and DC (Figure 1):

• The monthly premium for the most popular PDP nationally, Wellcare Value Script, is increasing in more states (33, including DC) than where it is holding steady (16) or decreasing (2), and will range from $0 to $42.40 across states and DC in 2026 (Figure 2).
• Enrollees in the second most popular PDP, Wellcare Classic, will see a premium reduction in 48 states (including DC), no change in 2, and an increase of less than $50 in 1. Monthly premiums will range from $0 to $45.70 across states and DC in 2026.
• Enrollees in the third most popular PDP, SilverScript Choice, will face the maximum $50 increase in their monthly premium in 30 states (including DC), but a premium reduction in 20 other states. The monthly premium will vary across states and DC from $14.70 to $116.

According to CMS, virtually all PDP enrollees are in plans sponsored by insurers that opted to participate in the voluntary demonstration for 2026. In the absence of this demonstration and CMS’s actions during the bidding cycle for 2026 to negotiate and even reject plan bids, PDP premium increases would likely have been larger. And with 58% of all Part D enrollees in Medicare Advantage drug plans in 2025 and 42% in stand-alone PDPs, most Part D enrollees are not likely to face premium increases of any magnitude. This is because Medicare Advantage plans can use rebate dollars from the federal government to reduce premiums for prescription drug coverage. According to CMS, Medicare Advantage drug plan premiums for 2026 are holding steady at considerably lower levels than stand-alone drug plans, on average, with many plans charging zero premium for drug coverage in 2026, as in previous years.

Even if the monthly premium for a given Part D plan isn’t increasing, or is even decreasing, premiums are only one part of the story when it comes to Part D coverage. As is commonly advised during open enrollment, Medicare beneficiaries may want to look beneath the hood to see what other Part D plan features may be changing, including what drugs are and aren’t covered on the plan’s formulary, tier placement of covered drugs, deductibles, and cost-sharing requirements. The tradeoff with a reduction in premiums is that drug coverage may be getting less generous, which could mean fewer drugs covered, higher cost-sharing requirements, or greater utilization management restrictions – or likely some combination of all three.