Medicare Part D beneficiary survey: 2026 affordability and access considerations for IRA-selected drugs

The Inflation Reduction Act of 2022 (IRA) directed the Centers for Medicare & Medicaid Services (CMS) to select and set prices for ten high-expenditure, single-source drugs in Medicare Part D that lack generic or biosimilar competition in 2026. For the first cycle of negotiations, maximum fair prices (MFPs) went into effect on January 1, 2026 for the following ten selected drugs:

• Eliquis (apixaban)
  
  
• Jardiance (empagliflozin)
  
  
• Xarelto (rivaroxaban)
  
  
• Januvia (sitagliptin)
  
  
• Farxiga (dapagliflozin)
  
  
• Entresto (sacubitril/valsartan)
  
  
• Enbrel (etanercept)
  
  
• Imbruvica (ibrutinib)
  
  
• Stelara (ustekinumab)
  
  
• NovoLog/Fiasp (insulin aspart)

Approximately 8.8 million individuals with Medicare Part D coverage used at least one of these drugs in 2023 to treat conditions such as cardiovascular disease, diabetes, autoimmune diseases, and cancer.[1] CMS described the program as intended to reduce federal spending and beneficiaries’ out-of-pocket costs.

Some respondents reported lower spending on the ten selected drugs, while others reported higher or unchanged costs amid other concurrent Medicare Part D changes, including premium increases, deductibles, drug plan exits (i.e., in standalone prescription drug plans, or PDPs), and increased cost sharing through the wider use of coinsurance.[2],[3] Other IRA affordability measures, including the out-of-pocket cap and pass-through of MFP pricing for beneficiaries with coinsurance, were intended to lower patient out-of-pocket costs.

Survey details

The research assessed how patients who incurred medicine costs in 2025 and were taking one or more of the ten selected drugs perceived the affordability of those treatments in 2026, after the MFP was implemented.

To assess the perceptions of beneficiaries whose drugs were subject to MFPs, DLA Piper conducted an online survey with 153 Medicare beneficiaries aged 65 or older who had taken one of the ten selected drugs in June and July 2026. The survey examined beneficiaries' experiences with drug costs, access, plan changes, and awareness of new cost protections under the IRA during its first year of implementation.

This report presents the survey findings and identifies considerations related to beneficiary affordability and access.

Key questions addressed and data gathered

Respondents were asked to self-identify the following:

• Health status, divided between “good,” “fair,” and “poor” (see Appendix: Survey methodology and respondent demographics for definitions)
  
  
• Plan type
  
  
• Urban or rural geography
  
  
• Use of either a PDP or Medicare Advantage drug plan (MA-PD)
  
  
• Age group
  
  
• Income level (annual household income below or above USD75,000 per year)
  
  
• Out-of-pocket spending in 2025

The survey’s questions were designed to determine whether there were differences among the given populations. Respondents with less than USD100 in out-of-pocket expenses in 2025 were not allowed to complete the survey. No more than 30 percent of respondents were allowed to complete the survey if they had less than USD1,000 per year in out-of-pocket expenses in 2025.

The selection criteria was used to compare expenses for these beneficiary populations in 2026 after MFPs took effect for the ten selected drugs.

Key findings

• Nearly half (46 percent) of respondents reported paying more for at least one of the ten selected drugs after MFPs took effect in 2026. Respondents were approximately 1.5 times likelier to report paying more than paying less.
  
  
• Beneficiaries reporting fair or poor health and those with incomes below USD75,000 per year reported higher rates of paying more for the ten selected drugs. Compared with respondents with household incomes above USD75,000, these respondents were 2.6 times likelier to report paying more for any of the ten selected drugs.
  
  
• Approximately 40 percent of beneficiaries were unaware of IRA cost protections, including the USD2,100 out-of-pocket cap and the option to spread costs over monthly payments.
  
  
• Thirty percent of respondents experienced problems obtaining prescribed medicines in 2026 (25 percent in 2025), with prior authorization and drug availability among the most common barriers. Among respondents with access difficulties, 33 percent of those indicating poor health ultimately obtained their prescribed medicine, compared with 73 percent of those indicating fair health and 91 percent of those indicating good health.
  
  
• Among respondents indicating poor health, 49 percent reported plan-level cost or coverage changes for the ten selected drugs, compared with 31 percent among those indicating fair health, and 25 percent among those indicating good health.
  
  
• Sixty-two percent of all respondents expressed concern about future access to medicines due to potential plan changes, with 78 percent of those indicating poor health, 61 percent indicating fair health, and 52 percent indicating good health.
  
  
• Respondents in a PDP were likelier to report premium increases in 2026, while respondents in an MA-PD were likelier to report paying more for their selected drugs in 2026.

As IRA implementation continues, the survey findings may inform additional monitoring of beneficiary costs, beneficiary education efforts, Medicare Part D market changes, and formulary restrictions associated with access concerns among beneficiaries who self-reported poor health.

Drug cost experiences and spending patterns

When asked whether their spending on any prescription drugs through July 2026 differed from spending during the same period in 2025, 59 percent of respondents answered "yes."

Among those who perceived a change, 46 percent reported paying more in 2026, while 14 percent reported paying less. An additional 41 percent stated that they were paying about the same as in 2025.

Chart 1: Respondents' perception of spending in the first half of 2026 compared with the first half of 2025

The survey found that respondents who indicated poor health were likelier to report that they were paying more in 2026. When asked whether their drug spending up to July 2026 felt different relative to the same period in 2025, 70 percent of respondents who indicated poor health said they were paying more, compared with 37 percent who indicated fair health and 41 percent who indicated good health.

Eight percent of respondents who indicated poor health reported paying less for medicines in 2026, compared with 17 percent who indicated fair health and 14 percent who indicated good health. These differences are statistically significant.[4]

Considering the same metric, 35 percent of respondents who had spent USD1,000 or more out of pocket in 2025 on drugs perceived their spending to be about the same in 2026, with 49 percent spending more and 16 percent spending less. Among the respondents who spent less in 2025 (out-of-pocket spending between USD100 and USD999), 49 percent reported spending about the same in 2026 relative to 2025, 40 percent reported spending more, and 11 percent reported spending less. These differences are statistically significant.[5]

Chart 2: Respondents’ perception of prescription drug spending in the first half of 2026 compared with the first half of 2025, by health status

When evaluating responses across each of the ten individual drugs, respondents reported paying more in 2026 relative to 2025, but with relatively small sample sizes. When adding responses across the ten selected drugs, 37 percent of respondents reported paying more in 2026 compared with 2025, and 24 percent of respondents reported spending less. Respondents could be taking multiple drugs and were able to reply more than once. Respondents were approximately 1.5 times likelier to report paying more than less.

Respondents indicating fair or poor health were likelier to report that they were paying more for the ten selected drugs in 2026, while respondents indicating good health were equally likely to report spending less or more. These differences are statistically significant.[6]

Table 1: Respondents’ perception of spending in the first half of 2026 compared with the first half of 2025: Likelihood ratio of paying more relative to paying less for the ten selected drugs

Ratio	Total	Good	Fair	Poor
Paying more / paying less	1.54	1.00	1.73	1.50

Chart 3: Respondents’ perception of prescription drug spending in the first half of 2026 compared with the first half of 2025, by health status

Respondents making below USD75,000 per year were 2.6 times as likely to report paying more, compared with respondents making more than USD75,000 per year, who reported paying 1.1 times more than respondents paying less for the ten selected drugs.

Respondents in an MA-PD plan were 2.3 times likelier to report paying more than less in 2026 for any of the ten selected drugs relative to 2025, and respondents in PDPs more often reported paying less (0.5 times as likely to report paying more). These differences are statistically significant.[7]

It is unclear why certain groups perceive spending more rather than less for any of the ten selected drugs, although some variation may be related to the type of drug plan. [8],[9]

In addition, MA-PD plans increasingly included deductibles, with 82 percent of enrollees in 2026 enrolled in a plan with a deductible, compared with 23 percent in 2024.[10]

Awareness of cost protections and payment plan enrollment

Respondents’ awareness of the cost protections in the IRA was uneven. When respondents were asked whether they knew that in 2026 they would not pay more than USD2,100 out of pocket for drugs covered by their Medicare drug plans, 55 percent answered “yes,” 39 percent answered “no,” and the remainder were unsure. When asked whether they knew they could pay for drug costs in monthly payments spread throughout the year, 56 percent were aware of this option, while 41 percent were not.

Chart 4: Respondents’ awareness of IRA affordability measures

Among 86 respondents who were aware of the Medicare Prescription Payment Plan, 29 percent had enrolled, while 69 percent had not. Of those who enrolled, 76 percent reported feeling more comfortable with the amount they pay for medicines, 20 percent said the plan had no impact on their ability to pay, and 4 percent reported it was still a challenge to afford their medicines.

Drug access challenges in 2026 compared with 2025

30 percent of respondents reported experiencing problems accessing drugs their doctor prescribed in 2026, including delays, having to call their doctor, or drugs not being available. This was slightly higher than the 25 percent of respondents who recalled experiencing issues in 2025. This question was asked broadly to include experiences with any prescription drug, not only the ten selected drugs.

Among those who experienced access issues in 2026, common challenges included:

• Healthcare providers being required to complete additional paperwork or prior authorization (50 percent)
  
  
• Drugs being unavailable at the pharmacy (48 percent)
  
  
• An inability to afford out-of-pocket costs (41 percent)
  
  
• Prescribed drugs being denied by the Medicare drug plan (33 percent)

Among those who reported access issues, 70 percent reported they were ultimately able to access the medicine their healthcare provider prescribed.

Chart 5: Reported access issues among respondents who experienced access challenges in 2026

When asked specifically about the ten selected drugs, 14 percent of respondents reported difficulty obtaining them through a pharmacy or mail-order service, with delays or out-of-stock situations as concerns. 85 percent reported that their medicines were available when needed. Respondents could report more than one issue.

Plan changes and coverage impacts

Eighty-seven percent of respondents remained in the same Medicare drug plan they had in 2025, while 13 percent switched to a different plan. Among those who switched, reasons included finding a plan with a lower premium (45 percent) and the previous plan being discontinued (25 percent).

Thirty-nine percent of respondents reported their monthly premiums had increased in 2026, while 45 percent stated that premiums had stayed the same, and 9 percent experienced a decrease. When comparing plan types, 65 percent of respondents in PDPs reported a premium increase, compared with 25 percent reporting higher premiums in an MA-PD.

Among the beneficiaries who reported out-of-pocket spending of USD1,000 or more in 2025, 50 percent reported that premiums had increased in 2026 relative to 2025.[11]

Chart 6: Changes in monthly premiums in 2026 compared with 2025, by plan type

Regarding plan coverage changes, 29 percent reported that their plan had changed coverage or was charging more out-of-pocket for one or more of the ten selected drugs compared with 2025, while 67 percent reported no change in how their plan covered these drugs. Forty-three percent of respondents who indicated poor health reported coverage changes for one or more of the ten selected drugs, compared with 27 percent indicating fair health or 20 percent of respondents indicating good health.[12]

Chart 7: Reported coverage changes for the ten selected drugs, by health status

Twenty-seven percent of respondents reported that their doctor had discussed changing their medicine because of changes in drug plan coverage or costs in 2026, with 12 percent indicating their medicine had actually changed as a result. Seventy-one percent indicated their doctor had not discussed any such changes. The rate was higher among respondents who indicated poor health: 51 percent indicated their doctor had discussed changing their medicine, and 27 percent reported that their medicine was ultimately changed because of changes in their health plan coverage. By comparison, 9 percent of respondents who indicated good health and 25 percent who indicated fair health reported speaking with their doctor about changing medicines due to coverage.[13]

This question was asked about all medicines, not only the selected drugs.

Beneficiary concerns and overall experience

A majority of respondents expressed concern about future access to their medicines. Sixty-two percent, or 95 respondents, reported being concerned that changes to their drug plan could affect their ability to continue taking their medicines in the future, with 19 percent being "extremely concerned" and 43 percent "somewhat concerned.” By contrast, 18 percent were “unconcerned,” with the balance being neither concerned nor unconcerned.

Seventy percent of respondents making less than USD75,000 per year reported being concerned, and 78 percent of respondents indicating poor health reported being concerned about future access to medicines.[14]

Chart 8: Respondents reporting concern about future access to medicines

When asked how the overall experience of filling prescriptions in 2026 compared with the prior year, 78 percent said it was about the same, while 16 percent reported it was more difficult, and 6 percent said it was easier.

Conclusion

The survey findings suggest that Medicare beneficiaries taking any of the first ten drugs selected for price negotiation experienced varying levels of affordability during the program’s first year of implementation.

Although the USD2,100 out-of-pocket cap and the Medicare Prescription Payment Plan include provisions intended to limit or manage beneficiary out-of-pocket costs, approximately 40 percent of beneficiaries are unaware of each provision. Nearly half of the respondents believed they were paying more for prescription drugs, including any of the ten selected drugs in 2026. Thirty percent of respondents experienced access issues, including prior authorization requirements and drug availability concerns.

When asked specifically about the ten selected drugs, respondents were approximately 1.5 times likelier to report spending more rather than less. This pattern was more pronounced among respondents who self-reported poor health.

Twenty-nine percent of respondents reported plan-level coverage changes affecting any of their drugs, which could include any of the ten selected drugs that had MFPs established, and 62 percent expressed concerns about future access. At the same time, the majority of beneficiaries remained in the same plan and pharmacy, and 78 percent rated the filling experience as unchanged from the prior year. These responses indicate that many respondents reported no substantial change in the day-to-day process of obtaining prescriptions, though some reported access and affordability concerns.

The survey findings highlight several areas for continued review:

• Respondents’ awareness of the USD2,100 out-of-pocket cap and the Medicare Prescription Payment Plan could provide context for beneficiary outreach and education efforts.
  
  
• Thirty percent of respondents reported access issues in 2026, including prior authorization requirements and formulary restrictions.
  
  
• The reported differences in cost experiences between MA-PD and PDP enrollees may inform further examination, with MA-PD beneficiaries 2.3 times likelier to report paying more for their selected drugs and 65 percent of respondents in PDPs noting premium increases relative to 25 percent in MA-PDs.
  
  
• Sixty-two percent of beneficiaries expressed concerns about future access, and 29 percent reported plan-level coverage changes, which may provide context for ongoing review of plan benefit design, market stability, patient costs, and access to needed medicines.

If implementation occurs alongside other affordability pressures – such as higher Medicare Part D premiums, greater cost sharing, or restrictive formularies – patient-level savings may vary beneficiaries who experience higher premiums, greater cost sharing, or access restrictions.

Many respondents did not report lower spending, and a majority expressed concern about future access to medicines. External analyses have identified premium growth, deductible changes, and formulary restrictions as areas for continued monitoring. Beneficiary experiences with affordability and access may provide context for other concurrent changes in the Medicare Part D market.

For more information, please contact the authors.

Appendix

Survey methodology and respondent demographics

The survey was conducted online with a USD20 payment for completion. A total of 153 Medicare beneficiaries across the United States confirmed they are currently taking at least one of the ten selected drugs.[15] Respondents were distributed across four US regions:

• South (46 percent)
  
  
• Midwest (22 percent)
  
  
• Northeast (19 percent)
  
  
• West (12 percent)

Sixty-five percent of respondents were aged 65 to 74, while 35 percent were aged 75 or older. The sample was 56 percent female and 44 percent male. The geographic split between urban and medium-sized metro areas and small towns and rural communities was nearly even, with 49 percent of respondents in urban or medium-sized metro areas and 50 percent in small towns or rural communities.

In 2025, the year before negotiated prices for the Initial Price Applicability Year 2026 took effect, respondents reported out-of-pocket spending on medicines. Thirty-seven percent spent between USD100 and USD1,000 on their drugs, 52 percent spent between USD1,001 and USD2,500, and 11 percent spent more than USD2,500.

Fifty-two percent of respondents reported annual household income below USD75,000, while 46 percent reported income of more than USD75,000. Thirty-seven percent reported having a disability. Sixty-five percent of respondents were enrolled in MA-PD, while 33 percent had a standalone PDP.

Respondents were asked to self-classify their health status into one of four categories:

• Good: “I can do nearly everything I want to do without my health limiting me” (29 percent)
  
  
• Fair: “I can do most of what I want to do without my health limiting me” (46 percent)
  
  
• Poor: “I am often limited in what I can do because of my health” (24 percent)
  
  
• Prefer not to answer

Fifty-eight percent of respondents had been taking one or more of the ten selected drugs for three or more years, with a median duration of five years. Nearly one in five (19 percent) of respondents reported being enrolled in the Medicare Part D extra help program. The respondent distribution across the ten selected drugs is shown in the table below. Respondents could be taking more than one of the ten selected drugs.

Drug	Respondents
Eliquis (Apixaban)	76
Enbrel (Etanercept)	19
Entresto (Sacubitril/Valsartan)	34
Farxiga (Dapagliflozin)	32
Imbruvica (Ibrutinib)	5
Januvia (Sitagliptin)	14
Jardiance (Empagliflozin)	41
Novolog/Fiasp (Insulin Aspart)	22
Stelara (Ustekinumab)	18
Xarelto (Rivaroxaban)	34
Total (some taking multiple of the ten selected drugs)	295

 

^{[1] CMS Press Release Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 August 2024 https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026
[2] The Uncertain Future of Medicare’s Stand-Alone Prescription Drug Plan Market and Why It Matters, KFF July 2025 https://www.kff.org/medicare/the-uncertain-future-of-medicares-stand-alone-prescription-drug-plan-market-and-why-it-matters/
[3] Medicare Part D Enrollment, Premiums, and Cost Sharing in 2026, KFF June 2026 https://www.kff.org/medicare/medicare-part-d-enrollment-premiums-and-cost-sharing-in-2026/
[4] These estimates are statistically significant at the 90-percent level using independent t-tests for means.
[5] These estimates are statistically significant at the 90-percent level using independent t-tests for means.
[6] Statistical significance tests (Wald Z-test on odds ratio) found no difference between “poor” or “fair,” but both groups were likelier than respondents indicating good health to report higher spending in 2026 (p-value = .04).
[7] These differences were all statistically significantly distinct from each other using pairwise comparisons of pay more versus pay less between each subgroup (Wald z-test on odds ratio, with a p-value less than .05)
[8] Medicare Drug Price Negotiation: Saving money for Medicare, but what about patients? DLA Piper
[9] Statistical significance test with p-value less than .05 (Wald Z-test on odds ratio)
[10] Source: KFF analysis of CMS data
[11] Statistical significance with a t-test at the 95-percent level comparing MA-PD to PDP respondent plan type.
[12] Statistical significance with a t-test at the 95-percent level for poor relative to good or fair health.
[13] Statistical significance with a t-test at the 95-percent level for poor relative to good or fair health.
[14] Statistical significance with a t-test at 95-percent level for the comparison between two income groups (below or above USD75,000 per year) and for the group with poor health compared with fair or good health.
[15] The goal was to achieve 150 completed surveys, but 153 results were returned before the survey was closed.}