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Medication Coverage Changes

If you are a Medicare recipient you should be aware that there are changes to prescription drug coverage that became effective in 2026.  The changes result in increases in the amount of co-pays you will be responsible for.  If you are on the Low-Income Subsidy program (LIS) the cap on co-pays is $5.10 (generic) $12.65 (name brand).

 

If you participate in the Value Based Insurance Design (VBID) and were paying $0 co-pays, you should be aware that the VBID program ended, and you will now be required to pay co-pays on prescription drugs.  The amount of the co-pays is capped at the levels mentioned above. Not all beneficiaries of the VBID were notified in advance of the ending of this benefit.  You should be prepared to pay a co-pay when you purchase your medications. If your prescription is for a generic drug you will be required to pay $5.10 and if it is a brand name drug you will pay $12.65.