Medicare Drug Price Negotiation
Does drug price negotiation apply to Medicare Advantage?
Last reviewed: · Big Sioux Benefits Data Desk
Yes. The negotiated maximum fair prices apply to Part D drug coverage however it is delivered, whether through a standalone Part D plan or bundled into a Medicare Advantage plan with drug benefits. The ten drugs in the first cycle are Part D drugs, and the negotiated price attaches to the drug under the Part D benefit, not to a particular plan type.
The qualifier: identical negotiated price does not mean identical cost to you. Medicare Advantage plans set their own tier structures and cost sharing, exactly as standalone plans do, so two people on the same drug with the same negotiated price can pay different amounts because they are in different plans. The $2,100 annual out-of-pocket cap applies to both.
What is the same and what is not
| Standalone Part D | Medicare Advantage with drug coverage | |
|---|---|---|
| Negotiated prices apply | Yes | Yes |
| $2,100 out-of-pocket cap applies | Yes | Yes |
| $615 maximum Part D deductible | Yes | Yes |
| Tier placement and cost sharing | Set by the plan | Set by the plan |
| Prior authorization and step therapy | Set by the plan | Set by the plan |
| Pharmacy network | Set by the plan | Set by the plan |
One thing to watch that is specific to Medicare Advantage: some plans have no drug coverage at all, and enrolling in one of those generally leaves you unable to add a standalone Part D plan, which is covered in does Medicare Advantage include drug coverage. The negotiation program does nothing for you if you have no Part D benefit. Your county's plan lineup is on the South Dakota county guide.
Sources
- CMS — Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 — prices effective January 1, 2026; accessed 2026-08-21
- CMS — Announcement of Calendar Year 2026 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (Part D benefit parameters) — CY2026 parameters; accessed 2026-08-21
- Medicare.gov — Costs for Medicare drug coverage — accessed 2026-08-21
Related questions
Do the fifteen drugs coming in 2028 include Part B drugs?
Yes. The third cycle, announced January 27, 2026 for prices effective January 1, 2028, is the first to include drugs payable under Part B as well as Part D. Earlier cycles covered Part D drugs only, so this is a genuine expansion of the program's reach.
Does my Medicare Advantage plan have to cover the negotiated drugs?
No. Negotiation sets a price; it does not mandate formulary inclusion. Plans still make their own coverage and tier decisions subject to CMS formulary requirements, so check the specific plan's formulary for the drugs you take.
Drug costs turn on your specific prescriptions, so the arithmetic is worth doing once, properly: book a free, no-pressure conversation, see your county's South Dakota plan lineup, or browse all answers. SHIINE, the state's free counseling program, is at 1-800-536-8197 and sells nothing.
Big Sioux Benefits is a licensed insurance agency, not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov, 1-800-MEDICARE, or SHIINE (South Dakota's SHIP) for all of your options.