Serving Your Patients Through Medicare Open Enrollment: Why 2026 Matters
By Kelli Stovall, RPh, MBA, VP Pharmacy Services and Clinical Programs
Published: October 16, 2025
As independent community pharmacists, you do far more than dispense. Every day, you counsel patients, help them navigate side effects, catch drug interactions, and serve as a healthcare access point in your town. One of the most powerful ways your role can be extended is by helping Medicare patients through open enrollment. As 2026 approaches, the stakes are higher than ever: there are meaningful benefit design changes, cost shifts, and a new requirement for pharmacies to engage with the Medicare Transaction Facilitator (MTF) for certain drugs under the Inflation Reduction Act. If we prepare now, we can protect patient access, preserve margins, and reinforce the pharmacy as trusted advisors.
In this post, I’ll walk through the following:
- Key 2026 Medicare changes to know.
- What does the MTF / Inflation Reduction Act drug negotiation mean for dispensing entities.
- How can pharmacists proactively guide patients in open enrollment as a community service.
What’s Changing in Medicare for 2026: Key Headlines
Here’s a summary of what independent pharmacies and patients need to understand going into the 2026 plan year (many changes stem from the Inflation Reduction Act and CMS’s implementation rules). Read more.
| Feature | What’s New / Changing in 2026 | Implication for Patients / Pharmacies |
|---|---|---|
| Out-of-pocket cap on Part D | The annual maximum out-of-pocket liability for Part D increases from $2,000 to $2,100. | Patients may see somewhat higher costs before they hit the cap; it becomes even more important to pick a plan with favorable cost-sharing. |
| Part D deductible maximum | The maximum allowable deductible that a Part D plan may impose rises from $590 to $615. | Some patients may see higher upfront drug costs, especially early in the year. |
| Prescription Payment Plan (MPPP) auto-renewal | For patients who use the Medicare Prescription Payment Plan (which lets them spread drug costs over monthly payments), CMS is making it easier: beginning in 2026, if a beneficiary opts in, they will be automatically re-enrolled unless they opt out. Medicare Prescription Payment Plan | CMS | This could smooth cash flow for patients. Pharmacists may need to help patients understand opting out, or how changes in price or plan affect their payment plan. |
| Part D premium stabilization changes | Under the Part D Premium Stabilization Demonstration, CMS is reducing the uniform base beneficiary premium reduction from $15 to $10 in 2026, and increasing the allowable year-to-year premium increase limit from $35 to $50. Centers for Medicare & Medicaid Services | Patients could see slightly larger variability in plan premiums. It makes comparing plans more important. |
| Medicare Advantage (MA) changes & provider directory transparency | CMS finalized rules requiring better access to provider directory data during the AEP, so patients can more reliably check which clinicians (and pharmacies) are in network. Also, aggregate payments to MA plans are increasing (on average ~5.06 %) in 2026. Centers for Medicare & Medicaid Services | If your pharmacy is out-of-network in some MA plans, patients may not know until late — helping them check network status becomes more valuable. |
| Negotiated Drug Price / Maximum Fair Price implementation (via MTF) | Under the Inflation Reduction Act, select Medicare Part D–covered drugs will be subject to negotiation, and maximum fair prices (MFPs) will apply starting January 1, 2026. The MTF (Medicare Transaction Facilitator) is the system CMS will use to pass through refunds or reimbursements, so pharmacies don’t get stuck absorbing the difference. | Pharmacies must enroll in the MTF and position themselves to flow the required data. Failure to do so can lead to financial mismatches or delays. |
| Other cost increases | Premiums, cost-sharing, deductibles in Parts A and B, and IRMAA adjustments are all expected to increase in 2026. | All beneficiaries should reevaluate whether their current plan is still best for them. |
These changes may sound technical, but they directly affect your patients’ bottom lines and your pharmacy’s reimbursement environment. Medicare and You Handbook 2026
What Is the MTF — and Why Your Pharmacy Must Engage
One of the most critical “behind-the-scenes” shifts for pharmacies in 2026 is the Medicare Transaction Facilitator (MTF) system for drugs under the IRA negotiation program (i.e., those with negotiated maximum fair prices).
What is the MTF?
- The MTF is a CMS-operated web platform designed to enable data exchange between dispensing entities (like community pharmacies) and drug manufacturers (and their agents or intermediaries) to effectuate the negotiated Maximum Fair Prices (MFPs) under the Inflation Reduction Act. Medicare Transaction Facilitator (MTF) Overview for Dispensing Entities
- For covered drugs under negotiation, the manufacturer must either ensure that pharmacies pay no more than the MFP when acquiring the drug or reimburse the dispensing entity for the difference. The MTF is the conduit for managing that reimbursement or refund flow.
- Pharmacies and other dispensing entities must enroll as MTF participants, choose system roles, identify where payments/refunds should be directed, and comply with the required data interfaces.
Enrollment and Timing
- CMS began sending invites to enroll in the MTF in 2025, and dispensing entities (pharmacies, long-term care, etc.) are highly encouraged to enroll in MTF agreements before January 1, 2026.
- There is not a firm “cutoff” date, but late enrollment could jeopardize your ability to receive reimbursement on negotiated drugs or delay refunds.
- Pharmacies also have the option to self-identify material cash flow issues to CMS during enrollment, which may affect how refunds are disbursed. Centers for Medicare & Medicaid Services
Why This Matters to Your Pharmacy
- If you fail to enroll or properly integrate with the MTF, you run the risk of being unable to claim or reconcile the difference between your acquisition cost and the Medicare-negotiated MFP, resulting in financial losses.
- Early enrollment gives you time to test and validate your processes, train staff, and avoid last-minute scrambling when January arrives.
Given this backdrop, open enrollment in 2025 (for 2026 coverage) is not just about patients picking plans — it’s also about your pharmacy positioning itself for the structural changes ahead.
Open Enrollment (October 15 – December 7): A Community Service, Not Just Business
The Medicare Annual Election Period (AEP), for switching or enrolling in Medicare Advantage or Part D plans, runs October 15 through December 7 each year. During that window, beneficiaries can:
- Enroll in or change a Medicare Advantage plan
- Enroll in, drop, or change a Part D drug plan
- For those in Medicare Advantage without drug coverage, add a drug plan
- Switch from Medicare Advantage back to Original Medicare (with or without a Part D plan)
As independent pharmacists, how we support patients during this period can make or break their experience — and deepen the trust relationship.
Why Helping Patients Navigate Open Enrollment is an Extension of Your Service
- Prevent cost shock
A patient may be comfortable in their existing plan — until a formulary changes, cost-sharing shifts, or manufacturer rebates alter net costs. By helping them review the Annual Notice of Change (ANOC) and compare contenders, you can prevent surprises like drug exclusions, higher copays, or network changes. - Ensure continuity of therapy
When a drug moves from tier to non-formulary, or a plan leaves your area, patients may need to switch plans or appeal transitions. If you catch these early, you can help patients avoid therapy interruptions. - Highlight benefit tradeoffs
Sometimes a slightly higher premium plan saves the patient money overall because of better coverage, lower deductibles, or more generous benefits. You can help them do the math (or point them to trustworthy tools). - Identify and help enroll in Extra Help / low-income subsidies
Many Medicare beneficiaries qualify for Social Security’s Extra Help program or Medicaid wraparound subsidies. You can guide them to check eligibility, complete forms, or connect with SHIP (State Health Insurance Assistance Program) counselors. - Educate about MTF-related changes
For patients on drugs subject to negotiation, you may need to explain how those drugs will work differently, how out-of-pocket cost may adjust, or answer questions about pharmacy reimbursement issues. - Deepen your role as a healthcare partner and community anchor
When you actively assist patients with plan selection, cost concerns, and transitions, your pharmacy becomes more than a drop-off point — it becomes a trusted navigator in the complex Medicare landscape. Medicare and You Handbook 2026
Practical Steps You Can Take
- Train your staff now on upcoming 2026 changes — especially on new cost limits, deductible changes, and MTF-related impacts.
- Host plan comparison events or “Medicare help weeks” where patients can bring their Part D summaries, list of medications, and review options with staff or a guest counselor.
- Prepare educational materials (e.g. mailers, posters, handouts) summarizing the big 2026 changes and open enrollment deadlines.
- Flag high-risk patients (polypharmacy, recent hospitalizations, high cost-sharing) and invite them for one-on-one plan reviews.
- Coordinate with local SHIP / senior centers / AARP / senior living communities to share resources or host joint seminars.
- Document conversations (e.g. “we reviewed 3 plans, patient chose Plan X”) — this helps in continuity, liability, and quality of service.
- Set deadlines internally so that by early November you’ve engaged as many patients as possible; leave buffer time for late decision-makers.
Conclusion: Seizing the Opportunity
Open enrollment isn’t just a mandatory period of paperwork and list-checking. For community pharmacies, it presents an opportunity to reaffirm your role as an indispensable health care partner in your community. As 2026 brings new pressures, shifting cost structures, and the addition of the Medicare Transaction Facilitator, those pharmacies that step forward to proactively guide, counsel, and enroll their patients will stand out.
By doing so, you help patients avoid surprises, preserve therapy continuity, and get maximum value from their Medicare benefits. At the same time, you safeguard your pharmacy’s role (and revenue streams) in a changing landscape.
