2026 Brought Progress on Drug Prices. What Will It Take to Improve Patient Access in 2027?

Prescription drug affordability remained a major focus of healthcare policy in 2026, with Medicare drug price negotiations, changes to prescription coverage and federal initiatives aimed at lowering medication costs.

Yet despite some meaningful progress, patients, particularly those with rare and chronic conditions, continue to face substantial expenses beyond their prescriptions. Insurance premiums, deductibles and other healthcare-related expenses can make it difficult to maintain treatment, even when medication costs go down.

Heading into 2027, the pharmaceutical industry has an opportunity to examine where price reforms are making a meaningful difference and where patients continue to encounter barriers to treatment.

How Medicare Reforms Bring Progress, With Important Gaps

The Inflation Reduction Act's Medicare Part D reforms have provided some financial relief, particularly for beneficiaries living on fixed incomes. The annual out-of-pocket spending cap and Medicare Prescription Payment Plan have made prescription expenses more manageable, particularly for patients who previously faced significant costs at the pharmacy counter.

However, the Part D cap will increase from $2,100 in 2026 to $2,400 in 2027.¹ For beneficiaries already managing the rising cost of living, that increase can be significant. The cap also excludes insurance premiums, medical appointments and treatments covered under Medicare Part B, including certain medications administered in clinical settings.

Traditional Medicare has no annual out-of-pocket maximum for Part A and Part B services.² A patient receiving an infused treatment, for example, may continue facing substantial expenses for administration and follow-up appointments, even when the medication itself becomes more affordable.

Medicare's drug price negotiation program will also expand in 2027, with negotiated prices taking effect for another 15 medications, including Ozempic and Wegovy. These changes may help eligible beneficiaries, but they address only part of the financial burden associated with treatment.

Insurance Coverage and Rising Costs Continue to Threaten Patient Access

Much of the national discussion around prescription affordability has centered on Medicare. Yet patients with commercial insurance continue to navigate challenges that can make prescribed therapies difficult to afford, including changing formularies, high deductibles and some benefit designs. At the same time, changes to Medicaid funding and eligibility requirements are expected to increase the number of uninsured Americans, while rising healthcare and living costs continue to put pressure on household budgets.

High-deductible health plans are particularly challenging for people with chronic conditions or those receiving a new diagnosis. Patients who require immediate treatment may face substantial upfront expenses before their insurance begins covering certain costs. For those managing chronic conditions, these expenses can recur at the beginning of each plan year.

Formulary changes create additional uncertainty. A patient whose medication moves to a higher tier may face increased coinsurance or new prior authorization requirements, even when their treatment needs remain unchanged. Step therapy policies can also require patients to try alternative medications before receiving coverage for a prescribed treatment.

Copay accumulators and maximizers further complicate affordability for patients using specialty medications. These programs can limit how manufacturer assistance contributes toward patients' deductibles and out-of-pocket obligations, leaving some patients facing significant costs after assistance is exhausted. Alternative funding programs raise similar concerns when employer-sponsored plans exclude certain specialty medications from coverage and direct patients toward outside assistance programs.

The administrative burden of navigating insurance adds another layer of complexity. Prior authorization requirements for medications and medical services can delay treatment, while coverage changes may force patients to navigate appeals or seek alternative therapies. For someone managing a complex condition, these requirements can make staying on treatment difficult even when a medication is covered.

For pharmaceutical manufacturers, these pressures make it increasingly important to evaluate patient access beyond prescription costs. Working with health care professionals and patient organizations to identify these barriers can help manufacturers understand where patients face the greatest risk of treatment interruption.

What Should Pharmaceutical Leaders Anticipate in 2027?

Despite some progress with prescription affordability, I expect that broader improvements in access will likely remain limited by insurance coverage and inflation impacting the overall cost of living.

The pharmaceutical industry should prioritize understanding how payer policies affect patients throughout their treatment journey, including when coverage changes, financial assistance is exhausted or administrative requirements delay care. These findings can inform patient support programs and discussions with payers about coverage policies.

Meaningful progress will require collaboration among policymakers, payers, the pharmaceutical industry, healthcare providers and patient organizations to address the full range of costs and barriers that can interfere with access to treatment. Patients need more predictable healthcare expenses and fewer administrative obstacles to maintaining prescribed treatment. Lower prescription prices represent progress, but patients will continue to struggle if other costs prevent them from starting or staying on treatment.

Tiara Green is president of Accessia Health.

References

1. How much does Medicare drug coverage cost? Medicare.gov. Accessed November 4, 2026. https://www.medicare.gov/health-drug-plans/part-d/basics/costs
2. Compare Original Medicare & Medicare Advantage. Medicare.gov. Accessed November 4, 2026. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage