Part D Plans Shift Coverage Toward Price-Negotiated Drugs
Panelists at AMCP Nexus 2026 described how Maximum Fair Prices are reshaping Medicare Part D formularies across the country.
Updated on Nov. 3, 2026 in Healthcare
Part D plans have covered required Maximum Fair Price drugs while cutting coverage of similar competing products in the same market basket. The Maximum Fair Prices for 10 Medicare Part D drugs took effect on January 1, 2026, according to panelists at the Academy of Managed Care Pharmacy Nexus 2026 meeting.
Why it matters
Because federal law requires plan sponsors to cover all Maximum Fair Price drugs and bars discrimination against them, formulary decisions for those products are effectively predetermined. Plans must now adjust the rest of their formularies while keeping effective therapies available to members, with incentives shifting toward lower net-price products.
Negotiated Maximum Fair Prices reduce list prices by 38% to 79% for the first 10 Part D drugs, effective January 1, 2026, with a second cycle of 15 drugs following in 2027. Panelists did not quantify how much formulary coverage has shifted or how much spillover into commercial plans has occurred.
The details
Panelists said Part D plans have been required to cover Maximum Fair Price drugs while trimming coverage of competing products in the same market basket. The shift has been most pronounced among stand-alone prescription drug plans and has also appeared in Medicare Advantage Prescription Drug plans, with little spillover into commercial formularies so far.
Timeline
January 1, 2026: Maximum Fair Prices take effect for 10 Medicare Part D drugs.
2027: Negotiated prices for a second cycle of 15 drugs take effect.
2028: The negotiation cycle expands to include Medicare Part B drugs.
Big Picture
The coverage shifts extend the Inflation Reduction Act's Medicare drug price negotiation provisions from price-setting into formulary design. A proposed CMS rule would make inclusion of Maximum Fair Price drugs on Part D formularies permanent.
Medicare Part D enrollees may see different covered drugs on their plan's formulary as plans shift coverage toward Maximum Fair Price products. Patients taking a competing drug in the same class should check whether their plan still covers it before the next plan year.
The takeaway
Medicare Part D formularies are becoming more predictable for negotiated drugs and more variable for everything else. Reviewing your plan's formulary each year helps you avoid surprises in coverage.
What happens next
Negotiated prices for a second cycle of 15 drugs take effect in 2027, and the 2028 cycle will add Medicare Part B drugs.
Further reading
Track broader changes in the Healthcare sector as federal drug pricing rules reshape prescription coverage.
