It's that time of year again, where PDP enrollment goes wild and we all kick it into high gear. And 2026 brings some of the most dramatic changes we've seen in years.
The Part D landscape is shrinking. We're down to just 360 standalone plans nationwide – that's 22% fewer options than last year – with major carriers like Elevance exiting the market entirely and others consolidating their offerings.
Formularies are taking massive hits across the board, crosswalk data is delayed (again), agent commissions are being reduced or even eliminated, and your clients need your expertise more than ever to navigate these changes.
In this guide, we'll break down everything you need to know for a successful AEP: which carriers are still competitive, where premiums are headed, why formulary checking is absolutely critical this year, and how to navigate the data challenges that are making it harder to prioritize your book of business.
Originally published October 8, 2019. Last updated October 2025.
Please Check Client Formularies
Before we get into all the Part D updates and some carrier highlights, I have to make sure every agent reads this: check everyone's formulary.
This year, we're seeing substantial cuts to formularies across the board.
Without a doubt, besides pricing, the formulary is the most important piece these PDP companies are putting forward.
While they're required by law to have representative medications in every family prescribed by CMS, the total number of drugs they cover varies significantly, and many carriers have reduced their drug lists substantially this year.
Please be diligent. Your clients need your help this fall perhaps more than ever before.
Dramatically Fewer Part D Plans in 2026
The number of Medicare Part D plans is dropping significantly in 2026, marking the third consecutive year of decline.
Beneficiaries will have access to just 360 stand-alone Prescription Drug Plans (PDPs) nationwide – a substantial reduction from 464 in 2025 (KFF). That's a 22% decrease in just one year.
On average, you'll see about a dozen PDP plans per state, though this varies by location.
Why the dramatic drop? Several factors are at play, including the Inflation Reduction Act, carrier exits, and reductions.
The IRA's Impact on Plan Design
When the Inflation Reduction Act changed the Maximum Out-of-Pocket (MOOP) from $4,000 to $2,000, it created a challenge for carriers trying to offer multiple plan options.
There has to be a certain level of actuarial difference between each plan a company offers – different deductibles, copays, and drug formularies. The new MOOP meant there wasn't as much room for carriers to build plans that were different enough from each other.
That's why we've seen carriers go from three plans to two, or even down to one. Some markets that had over 30 PDPs just a few years ago now have only a dozen.
Major Carrier Exits and Reductions
- Elevance/Anthem has exited the PDP market entirely (Healthcare Dive), affecting approximately 400,000 members
- Centene is discontinuing one of Wellcare's three PDP options (KFF)
- Health Care Service Corporation is discontinuing one of Cigna's three plans and withdrawing from several regions (KFF)
- CVS/Aetna/SilverScript consolidated from three plans down to just one – the SilverScript Choice plan – in 2025 and continues with only that single option for 2026 (KFF)
Many insurers with smaller footprints have determined that stand-alone drug plans simply aren't viable anymore, especially with increased plan liability under the Inflation Reduction Act. Those offering both PDPs and Medicare Advantage are shifting resources toward the more lucrative MA market.
Despite the reduction in stand-alone PDP options, the availability of Medicare Advantage plans that include drug coverage (MA-PDs) continues to grow. This trend is worth noting, as more clients may shift toward MA-PDs to take advantage of bundled coverage options.
Premiums Are Actually Decreasing
The average stand-alone Part D premium is decreasing from $38.31 in 2025 to $34.50 in 2026, a drop of $3.81 (CMS).
This is better than many expected, especially after the Trump administration scaled back the Part D Premium Stabilization Demonstration support.
For 2026, the federal subsidy dropped from $15 to $10 per month, and the maximum allowed premium increase rose from $35 to $50.
Many thought this would lead to dramatic premium hikes, but CMS actively negotiated with carriers during the bidding cycle – and even rejected bids that included unacceptable premium increases.
The reality on the ground is mixed, though. Premium changes vary widely by plan and by state:
- Some states now have up to six PDPs available for $0 premium (KFF)
- Wellcare Value Script is increasing in 33 states (including DC) but holding steady or decreasing in 18 others, ranging from $0 to $42.40 depending on location (KFF)
- Wellcare Classic is decreasing in 48 states (including DC), with premiums ranging from $0 to $45.70 (KFF)
- SilverScript Choice faces the maximum $50 increase in 30 states (including DC) but is decreasing in 20 others, with premiums ranging from $14.70 to $116 (KFF)
Remember: historically, two-thirds of all PDP plans sold in the country have been the top two lowest-priced plans. Most people choose based on premium, so those $0 premium products will be popular – but make sure the formulary works for your client's medications.
Clients Could Still Struggle to Find Drugs
The independent pharmacy issue from last year continues. Many independent pharmacies are still hesitant to stock Medicare's negotiated-price medications due to the upfront costs involved.
This could affect your clients' ability to access certain drugs, especially in areas that rely heavily on smaller, local pharmacies.
While the major pharmacy chains (Walgreens, CVS, Walmart) are better equipped to handle this, clients in rural areas or those who prefer their local mom and pop pharmacy may face challenges getting drugs like Eliquis, Jardiance, and Januvia.
The competitive pressure from big chains on smaller pharmacies isn't helping the situation, either.
Navigating Data Challenges This AEP
Here's something important to keep in mind: brokers are still waiting for critical crosswalk information that normally arrives in early October. This data tells you which clients have been automatically moved from discontinued plans to new ones, helping you prioritize who to call first during AEP.
Crosswalks happen when a carrier eliminates a plan but creates or assigns members to another similar plan rather than making everyone re-enroll.
For example, if a carrier offered three plans and eliminated one, they might automatically move those members into one of their other two plans – but only if the government approves the plans as having similar enough benefits.
Without this information, it's harder to develop your plan of action for AEP. But if I know anything at all, it's that the experienced brokers will navigate this just fine. We've dealt with these types of hurdles before, and we'll get through them again.
Non-Commissionable Plans Continue to Skyrocket
This is worth noting: the number of non-commissionable plans for both PDPs and MAPDs continues to grow dramatically. What used to fit on one page now spans several hundred plans – mostly PPOs, with a sprinkling of HMOs.
This reflects the financial pressure the insurance industry is facing, driven by lower government reimbursements and higher utilization rates.
2026 Part D Carrier Highlights
As always, everything depends on your location, but certain carriers are standing out for 2026.
Wellcare
Despite discontinuing one of its three plans, Wellcare remains a powerhouse with competitive offerings across most states. Multiple states have Wellcare plans available at $0 premium.
- Wellcare Value Script: The most popular PDP nationally continues to perform well, with $0 premiums available in numerous states
- Wellcare Classic: Showing premium decreases in 48 states
Keep in mind Wellcare's history and service record when guiding client decisions. Also, remember that Wellcare does not pay commission on Part D plans.
Cigna/HealthSpring
Cigna Healthcare (HealthSpring) remains competitive in many markets, though they've scaled back to two plans in most areas.
Their plans continue to offer:
- Low to $0 copays on many generic drugs at preferred pharmacies
- $0 copay options for select medications through preferred home delivery
- Comprehensive drug lists and formularies
Humana
Humana continues to be a strong competitor with about 83% of their standalone PDP plans featuring lower premiums for 2026 (Managed Healthcare Executive).
They offer three standalone Part D options:
- Humana Premier Rx: The most comprehensive option with $0 deductible covering 3,700+ prescription drugs
- Humana Value Rx: Mid-tier plan with $0 deductible for Tier 1-2 drugs and $0 copays for Tier 1-2 at preferred pharmacies, covering 3,600+ drugs
- Humana Basic Rx: Designed for Extra Help recipients, with a potential $0 premium for those who qualify
All Humana Part D plans include preferred retail pharmacies such as Albertsons, Walmart, Sam's Club, Publix, H-E-B, and Costco, plus access to CenterWell mail-order pharmacy.
SilverScript (CVS/Aetna)
SilverScript – Aetna's Part D brand owned by CVS Health – is now down to just one plan nationwide: the SilverScript Choice plan.
While premiums technically range from $14.70 to $116 across all states (CVS Health), most areas see premiums in the $90-$110 range. The plan offers $0 premiums only to Extra Help recipients in 18 states.
With so many lower-cost options available from other carriers, it's unclear what would make this plan stand out for most clients, unless there's something unique about the formulary for specific drugs your client needs.
Tools to Help You This AEP
IntegrityCONNECT remains your best resource for drug comparisons and plan analysis.
You can:
- Quote and enroll clients directly in the system
- Compare drug costs across multiple plans
- Review formularies efficiently
If you haven't registered yet, make sure you do that now.
Learn more: Game-Changing Technology Now Available: IntegrityCONNECT
Conclusion
You don't know what hurdles you'll run into until we start on October 15th, but experienced agents will navigate this successfully. We've all dealt with these types of changes before, and we'll get through this AEP just fine.
Make sure you register for an IntegrityCONNECT account if you haven't already.
New to Part D sales? Check out our comprehensive sales guide, How to Sell Medicare Part D.
