January is the most expensive month of the year for seniors on medication. On December 31, you might have been enjoying “Catastrophic Coverage,” paying zero dollars for your prescriptions. On January 1, that protection vanished. The calendar reset means your deductible is back, your out-of-pocket accumulations are at zero, and your plan’s new rules have kicked in.
In 2026, this annual reset is more painful than usual. To manage the new federal $2,100 out-of-pocket cap, insurers have quietly restructured their copay tiers. They have moved millions of drugs from “flat fee” tiers to “percentage-based” tiers. This means your first few trips to the pharmacy this winter will cost significantly more than you budgeted. Here are the six specific drug costs that have reset higher right now.
The $615 “First Fill” Deductible
The most immediate shock comes from the standard Part D deductible. For 2026, the maximum allowable deductible has risen to $615. If your plan utilizes this standard deductible, you must pay 100% of the cost of your medications until you hit that number.
The Impact: If you take an expensive heart medication that costs $500 a month, you will pay the full $500 in January and another $115 in February before your insurance pays a dime. Last month, that same drug might have been free because you had already met your 2025 deductible.
The Tier 3 “Coinsurance” Shift
Historically, “Tier 3” (Preferred Brand) drugs came with a manageable flat copay, often around $45. In 2026, to protect their profit margins against the new federal cap, many plans have converted Tier 3 into a coinsurance tier.
The Impact: Instead of paying a flat $45, you now pay 17% to 25% of the drug’s full retail price. For a drug with a list price of $800 (like many common blood thinners or inhalers), your share is now $200. You will pay this inflated amount every month until you reach the $2,100 annual cap.
The “Non-Preferred” Generic Bump
We are used to generics being cheap. However, plans are increasingly moving newer, more complex generics into “Tier 4” (Non-Preferred Drug).
The Impact: A generic drug that used to be in Tier 2 (with a $10 copay) may have been moved to Tier 4 this year. Tier 4 drugs almost always carry a coinsurance of 40% to 50%. You might walk into the pharmacy expecting to pay $10 for a generic antidepressant and be handed a bill for $85 because the plan reclassified the drug during the annual update.
The “Standard Pharmacy” Surcharge
Your plan has likely narrowed its list of “Preferred” pharmacies for 2026. A pharmacy that was “Preferred” last year might now be “Standard.”
The Impact: The difference in copay is drastic. A Tier 1 generic might cost $0 at a Preferred pharmacy but $15 at a Standard one. If you auto-refilled your prescriptions at your usual grocery store chain without checking the 2026 directory, you effectively volunteered to pay a surcharge on every single bottle.
The “Formulary Exclusion” Cash Price
To steer patients toward the 10 drugs with newly negotiated federal prices, insurers are dropping competitor drugs from their formularies entirely.
The Impact: If you are taking a brand-name diabetes or arthritis drug that competes with one of the “negotiated” drugs, your plan may have stopped covering it on January 1. When a drug is excluded, you pay 100% of the cash price, and none of that money counts toward your $2,100 annual cap. You are paying thousands of dollars for a drug that effectively no longer exists in your insurance universe.
The “Brand-Over-Generic” Penalty
In a bizarre twist of rebates, some Part D plans have placed the Brand Name version of a drug on a lower tier than its Generic equivalent.
The Impact: You might be doing the “responsible” thing by asking for the generic, only to find out it costs more. For example, a plan might charge a $40 copay for the Brand Name inhaler (because they get a rebate) but charge 33% coinsurance for the Generic version. If you are on auto-pilot asking for generics, you could be overpaying by $100 a month.
Check the “Tier” on the Receipt
Do not just sign the credit card pad at the pharmacy counter. Look at the receipt. If a copay seems high, ask the pharmacist, “What Tier is this drug on this year?” If it is Tier 3 or 4, ask if there is a Tier 1 or 2 alternative. In 2026, the only way to lower your reset costs is to switch drugs to fit your new formulary reality.
Did your “Tier 3” copay jump from $40 to $150 this month? Leave a comment below—tell us which plan you have!
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