This article was created in partnership with Humana
Sweeping changes over the past few years to Medicare Part D will continue in 2026, with insurers recalibrating offerings to align with new federal mandates and evolving member expectations. Steering the ship for Humana is TJ Gibb, President of Medicare Part D. Speaking to Insurance Business (IB), he explained the most significant changes coming down the line include contraction of the number of carriers, federal drug price negotiations and member cost-sharing caps.
“In our industry, there are fewer plans in the market, meaning multiple carriers have combined their plans down to one or sometimes two plans. Some other carriers have exited the market altogether.”
TJ Gibb
And amid this churn, Humana is preparing for consistency where it counts.
“Some of the regulatory requirements are pretty routine,” Gibb told IB, referencing the Inflation Reduction Act (IRA) mandates. “There’s a maximum out-of-pocket that’s already in place - $2,000 is increasing to a limit of $2,100. Your maximum Medicare deductible will go from $590 a year to $615.”
2026 also marks the first year in which the federal government will enforce price negotiations for selected high-cost drugs - a milestone development under the IRA.
“The drugs that are negotiated by the government for the first time, with those new prices included in 2026 plan offerings,” explained Gibb. “All the carriers are required to cover the drugs on the negotiation list.”
Still, Gibb was clear that this doesn’t have to herald drastic upheaval. As he told IB, every year there’s some changes in formularies and expects consumers to have expansive formularies with coverage of thousands of life-saving medications. In 2026, many of our plans will have similar benefits and even lower premiums compared to 2025, according to Gibb.
“Every year, carriers make different choices on which drugs to cover. Drug formularies typically offer both brand and generic options as well as biosimilars, which are gaining in popularity due to the lower price points for consumers. Many formularies will offer generic drugs at $0 cost for members.”
One of the most impactful shifts in the Part D program was the introduction of an annual maximum out-of-pocket cap, or MOOP. A change that may shape member plan purchasing behavior.
“Member annual prescription drug costs are more predictable now. Your monthly premium plus estimated cost sharing out of pocket costs allows members to more accurately budget their expenses.
“However, everyone has unique circumstances that will influence the best plan for them. The lowest premium is not always the best plan for your situation. Everybody’s different. Every situation is different. It’s not a one-size-fits-all.”
For current and prospective Humana members, preparation begins with understanding premiums, drug coverage, cost-sharing details, pharmacy options and high-quality customer service.
“First and foremost, look at the formulary and make sure your drugs are covered,” Gibb stressed. “If your current medication is not covered, check if another drug is an option - you may need to contact your doctor to help make this decision. If your drug is not covered and the plan does not have a substitute, you would be well served to seek an alternative plan that does cover your specific medicine.
“It is important to look at the monthly premiums to make sure that’s something affordable. You may have other out-of-pocket costs, such as copays, coinsurance and/or a deductible.”
Another frequently overlooked factor? Pharmacy networks.
“If you have a grocery store or local pharmacy you really like… or if you want a mail-order benefit - all those things matter and need to verify they are in the plan’s network,” added Gibb. “Do they have preferred cost sharing, meaning it’s a lower cost for you, or do they have standard cost sharing?”
As part of this outreach and transparency push, Humana and other carriers will distribute key documents typically in September - including the Annual Notice of Change and updated Prescription Drug Guides.
“Candidly, a lot of people ignore those. They’re lengthy, comprehensive documents, but strongly encourage people to review them to see what has changed in their plan. Maybe their drugs have been removed from formulary, or they have shifted on the cost sharing tier impacting your pocketbook.” If you have an insurance broker, contact them to assist in the review process and potential selection of a new plan.
Digital platforms are also playing a growing role in the member decision-making process. Humana.com has lots of helpful tools, educational materials, existing plan information and alternative plans all available online. Gibb also mentioned Medicare.gov and the Plan Finder tool with helpful resources.
With Medicare Part D undergoing its most significant transformation in over a decade, Humana is taking a proactive approach, emphasizing regulatory alignment, member education and plan flexibility.
“We strive to offer convenient access to critically important medications for our members, while diligently working to keep plans affordable,” explained Gibb.
And, for beneficiaries, Gibb stressed to read the documents, use the tools and essentially evaluate your needs carefully sooner rather than later.
“There are a lot of things you can learn just by doing some research using different digital assets available online.”
