Why is Medicare Part D dropping coverage of brand-name drug for 2026?

Dear Toni: I signed up for a supplemental Medicare Plan G and a Medicare Part D prescription drug plan, both of which started in January 2021. These two plans have served me well.

I just received information that my current Part D plan will no longer cover Humira, which I take twice a month as an injection for Crohn’s disease. I have looked at other 2026 Part D plans on the Medicare.gov site and discovered that there is not one that covers Humira.

Do you know of another Part D provider that will cover some or all of the costs for Humira? Any recommendations you can make will be highly appreciated. — Gene, Sugar Land, Texas

Dear Gene: I do not have good news about your Humira prescription. You’re right: I also searched the Medicare.gov site for this medication without finding a stand-alone Part D plan that covers it. The website showed the total cost beginning Jan. 1 for 12 months of Humira will be $99,691.68, or $8,307.64 per month.

After some internet sleuthing, it appears that 2026 Part D formularies are not covering Humira because of the availability of similar but less expensive alternative medications.

Gene, you should ask your prescribing physician if there are alternatives to Humira that you can take instead. Also, contact AbbVie, the manufacturer of Humira, at 800-222-6885, and ask if you qualify to receive any type of prescription drug assistance.

This has been the most stressful Medicare open enrollment period that I have experienced. It is extremely important that the 69 million Medicare beneficiaries visit Medicare.gov to verify that all of their prescriptions are covered, whether they have a stand-alone Medicare Part D plan or a Medicare Advantage HMO/PPO plan with a prescription drug plan.

Below are some key costs related to 2026 Medicare prescription drug coverage:

Initial deductible: $615.

Initial coverage stage: During the initial coverage period with the six drug tiers, the Part D plan pays its share of the cost of your drugs, and you pay your share of the cost until the maximum amount of $2,100 out of pocket is met. Then you move to the catastrophic coverage stage.

Catastrophic coverage: There is a $0 out of pocket once a Medicare beneficiary enters the catastrophic coverage stage. Medicare will pick up all costs of covered prescriptions whether brand-name or generic with a stand-alone Part D plan or a Medicare Advantage plan with a Part D plan included.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.