Why won’t Medicare cover my brand-name prescription drug anymore?

Summary

Medicare Part D plans for 2026 are dropping coverage for some high-cost brand-name drugs — Humira is a prominent example. The article explains that insurers are removing coverage because cheaper alternative medications exist, and it urges beneficiaries to check formularies during open enrolment to avoid surprise costs. It also outlines key Part D cost limits and offers practical next steps for patients who find their drug is no longer covered.

Content summary

A Medicare beneficiary discovered that no 2026 stand-alone Part D plan on Medicare.gov will cover Humira, a biologic used for Crohn’s disease. The insurer listings show the annual cost for Humira beginning 1 January would be roughly $99,692 — about $8,308 per month — so plans are favouring lower-cost alternatives. The columnist advises checking with your prescriber about substitute medicines, contacting the drug maker (AbbVie) about assistance programmes, and verifying coverage on Medicare.gov for both stand-alone Part D and Medicare Advantage plans. The piece also reminds readers of Part D cost stages: a $615 initial deductible (2026), an initial coverage stage with a $2,100 out‑of‑pocket limit before catastrophic coverage, and then catastrophic coverage where covered drugs have $0 out‑of‑pocket cost.

Key Points

Plans are removing coverage for some brand-name drugs (Humira cited) because less expensive alternatives are available.
Estimated cost of Humira for 12 months (from listings): about $99,691.68 — making it economically untenable for many Part D formularies.
Check Medicare.gov during open enrolment to confirm whether your prescriptions are on your plan’s formulary for 2026.
Talk to your prescribing clinician about therapeutic alternatives that plans are more likely to cover.
Contact the manufacturer (AbbVie for Humira) to ask about patient assistance or copay support programmes.
Important 2026 Part D figures highlighted: $615 initial deductible and a $2,100 out‑of‑pocket threshold before catastrophic coverage; catastrophic stage has $0 out‑of‑pocket for covered drugs.

Context and relevance

This matters because roughly 69 million Medicare beneficiaries must pick plans each year and small formulary changes can produce very large costs for people on high-cost biologics. Insurers and plan sponsors shift formularies to manage costs when biosimilars or other alternatives appear. For patients on specialised medicines (autoimmune, oncology, rare disease therapies), these changes can mean switching drugs, paying steeply, or seeking manufacturer help — all requiring proactive action during open enrolment.

Why should I read this?

Quick and blunt: if you or someone you know is on an expensive brand biologic, this could hit your wallet hard next year. The article tells you where to look (Medicare.gov), who to call (your doctor and the drug company), and the cost thresholds to be aware of — essentially saving you from nasty sticker shock and giving you immediate steps to take.