Questions? Call 1.877.386.0206 or
At least 350 brand‑name medications are expected to see U.S. price hikes in 2026, including vaccines and blockbuster drugs for cancer, COVID‑19, and chronic conditions. For patients and families nationwide, those increases will pile onto already rising premiums and out‑of‑pocket costs, making access to a full‑service prescription assistance program more important than ever.
The states that will likely see the biggest savings from Medicare drug negotiations are those with the largest Medicare populations, the highest use of expensive Part D and Part B drugs, and a high share of people with chronic conditions—states like Florida, Texas, California, New York, and Pennsylvania. For people in South Carolina, especially retirees in communities like Mount Pleasant, the savings may not be the very highest in the nation, but they will still be meaningful—especially for those who rely on negotiated drugs for chronic conditions.
Medicare’s new price negotiation authority, created under the Inflation Reduction Act, allows the Centers for Medicare & Medicaid Services (CMS) to negotiate prices for a limited list of high-spend drugs each year. CMS focuses on drugs with the highest total Medicare spending, long time on the market, and no generic or biosimilar competition, which means the impact is concentrated on medications that millions of people take for chronic, high-impact conditions.
Even though negotiated prices are set nationally, the savings look different state by state because of how many people in each state actually use those drugs. States with more Medicare enrollees, higher rates of diabetes, heart disease, arthritis, cancer, and autoimmune conditions, and greater reliance on expensive brand-name medications will see larger aggregate reductions in Medicare spending and out-of-pocket costs.
When you look at overall Medicare spending, certain states stand out because of their size and demographic mix. States most likely to see the biggest total dollar savings from negotiated drug prices include:
From a patient’s perspective, that doesn’t mean people in other states are left out; it simply means the largest total savings will cluster where Medicare spending is already highest.
Because negotiated prices apply nationwide, the “which states benefit most” conversation is really about where the drugs on the negotiation list are used most heavily. States with these characteristics will tend to see larger total savings:
On the other hand, a state with fewer older adults, greater reliance on generics, or lower uptake of the negotiated drugs will see smaller aggregate savings—even though individual patients may still benefit.
Many patients are in a similar situation: they have Medicare, but they still struggle with high out-of-pocket costs for necessary medications. Negotiated prices help in several ways:
For those whose medications are not yet included in negotiations, working with a patient assistance program can unlock additional savings through manufacturer programs, grants, and other sources.
Even in the states with the largest projected savings, negotiated prices alone rarely solve every affordability problem, especially for people taking multiple brand-name medications. That’s where a full-service prescription assistance partner becomes essential.
An organization like Simplefill helps patients:
In practice, the best time to seek help is as soon as your prescription costs start to strain your budget, rather than waiting until you are deep into the year or already in a coverage gap.
Warning signs include:
A full-service prescription assistance company can review your situation, identify programs and potential savings, and handle the applications and renewals for you so you can focus on your health.
Simplefill is a full-service prescription assistance company that researches, qualifies, and maintains patients’ enrollment in all sources of assistance available to them.
Apply today by calling 877-386-0206. A caring Simplefill representative will contact you within 24 hours to discuss your application and, if qualified, enroll you in the program.
The Medicare Drug Price Negotiation Program lets Medicare negotiate prices directly with drug manufacturers for a limited list of high-spend Part D and Part B drugs, based on factors like total Medicare spending, years on the market, and lack of generic or biosimilar competition. Negotiated prices are then implemented nationally for eligible beneficiaries, with new groups of drugs added over time.
The first negotiated prices apply to an initial group of drugs and begin phasing in over the middle of this decade, with additional drugs and price changes scheduled in subsequent years. For many people with Medicare Part D, the most noticeable savings will come as negotiated prices combine with the new annual prescription drug cap to limit overall out-of-pocket spending.
No, only a select list of high-impact drugs is eligible for negotiation, and certain medicines—such as orphan drugs for very rare conditions, plasma-derived products, generics, and biosimilars—are excluded from the program. Many other prescriptions will continue to be priced through normal plan negotiations, formulary decisions, and existing manufacturer discount or prescription assistance programs.
If your drug is not yet negotiated, you may still benefit from the new Medicare prescription drug cap, plan-level discounts, or manufacturer and nonprofit patient assistance programs that reduce out-of-pocket costs. A full-service medication assistance program can help you compare options, check your plan’s formulary, and enroll in available programs so you can keep affording your medications over the long term.
Drug shortages are a serious issue throughout the country, hiking prices beyond their already difficult-to-afford rates and making it a challenge for people to receive the medications they need for conditions like cancer, heart disease, and ulcerative colitis.
In 2026, some healthcare plans are removing certain medications from their formularies. Some may not be fully removing them but could instead require prior authorization or step therapy before you can access the drugs you need. As a result, you could struggle to afford lifesaving medications for chronic conditions like asthma or HIV.
In 2026, a number of changes are coming to Medicare. The goal behind these changes is to offer lower medication costs overall, but that is not necessarily what’s going to occur for everyone.
Many American lawmakers and voters have become increasingly concerned about drug price transparency. As medication costs continue to rise and people struggle to pay for lifesaving care, some states have passed legislation to bring more transparency to how medications are priced.
If you have a chronic condition such as COPD, rheumatoid arthritis, or diabetes, you may constantly face worries about how to afford your medications. One of the most important ways to advocate for your own health is to communicate clearly with your doctor about drug prices.
One of the most important achievements of the Biden administration was the Inflation Reduction Act (IRA) of 2022. Among the act’s many provisions was one that gave Medicare the power to negotiate drug prices for certain medications via the Medicare Drug Price Negotiation Program (DPNP).
Direct-to-consumer pharmaceutical advertisements have been a focus of the FDA and the U.S. Department of Health and Human Services for some time. There have been concerns about the misleading way that pharmaceutical companies promote certain medications. New prescription drug advertising reforms strive to change all of this.
In 2024, the Food & Drug Administration gave the state of Florida permission to import certain medications from Canada. This is part of the fight to help Americans obtain the type of drug prices that other countries pay. The decision from the FDA took many by surprise because it was the first time that the FDA had made such a decision.
