Which drugs will be negotiated in 2026?

Doctors often recommend getting rid of or avoiding specific over-the-counter and routine medications because new evidence shows they are ineffective or carry unnecessary risks.

Based on recent medical guidance highlighted by physicians (such as recent recommendations featured by the Washington Post), here are 5 medications doctors frequently advise reconsidering or dropping from your medicine cabinet:

1. Oral Phenylephrine

• What it is: A common oral decongestant found in many over-the-counter cold, flu, and sinus products (like certain versions of Sudafed PE or DayQuil).
• Why doctors say to avoid it: The FDA determined that oral phenylephrine is completely ineffective as a nasal decongestant.
• What to do instead: If you need a real oral decongestant, ask a pharmacist for pseudoephedrine from behind the pharmacy counter, which actually works.

2. Diphenhydramine (Benadryl)

• What it is: A first-generation antihistamine widely used for allergies and sleep.
• Why doctors say to avoid it: Especially for adults over 65, it causes severe side effects like heavy daytime grogginess, confusion, high risk of falls, and trouble urinating. Chronic use has also been linked to cognitive decline.
• What to do instead: Switch to newer, safer second-generation antihistamines like loratadine (Claritin) or cetirizine (Zyrtec).

3. Daily Low-Dose Aspirin (for Primary Prevention)

• What it is: Taking a daily aspirin to prevent a first heart attack or stroke.
• Why doctors say to avoid it: Updated guidelines advise against starting daily aspirin if you have never had a cardiovascular event, because the risk of dangerous stomach bleeding often outweighs the preventative benefits. (Note: If you already take it under strict doctor's orders for an existing heart condition, do not stop without talking to them).
• What to do instead: Talk to your physician to re-evaluate your personal risk factors and see if a daily aspirin is still appropriate for you.

4. Docusate Sodium (Colace)

• What it is: A widely sold over-the-counter stool softener.
• Why doctors say to avoid it: Robust clinical trials have shown it is largely ineffective as a standalone treatment for constipation.
• What to do instead: Increase your intake of water and try a natural fiber supplement or osmotic laxative if recommended by your care team.

5. Old Codeine Cough Syrup

• What it is: Prescription opioid-based cough medicine kept in home medicine cabinets.
• Why doctors say to avoid it: Studies show codeine cough syrup performs no better than a placebo for suppressing coughs, but carries serious risks of dependence, accidental misuse, and dangerous slowed breathing.
• What to do instead: Safely dispose of leftover prescription narcotics through a community drug take-back program.

GoodRx is not "better" than Medicare Part D overall because GoodRx is a discount coupon program, not insurance.

Key Differences

• Medicare Part D is health insurance. It protects you against catastrophic costs, covers expensive brand-name and specialty medications, and includes an annual out-of-pocket spending cap ($2,100).
• GoodRx is a free price-comparison and coupon tool. It does not replace insurance and does not count toward your Medicare deductible or out-of-pocket maximum.

When GoodRx is Better

• Cheap Generic Drugs: GoodRx often beats insurance copays for low-cost generic medications.
• Uncovered Drugs: If a prescribed medication is not on your Part D plan's formulary (list of covered drugs), GoodRx can lower the cash price.
• Before Meeting Deductibles: If your Part D plan has a deductible and the cash price with GoodRx is lower than what you would pay out of pocket initially.

When Medicare Part D is Better

• Brand-Name and Specialty Drugs: GoodRx offers very little savings on expensive brand-name drugs, which can cost thousands of dollars a month and easily bankrupt a cash-pay patient.
• Safety Net: Part D caps your annual out-of-pocket spending, whereas GoodRx offers no yearly cap or protection if you develop a severe, expensive health condition. Dropping Part D entirely also risks permanent late-enrollment penalties.

You cannot combine GoodRx and Medicare Part D at the register; you must choose to run a prescription through either your insurance or as a cash transaction using GoodRx. Many beneficiaries keep a Part D plan for major protection while spot-checking GoodRx for cheaper generic fills.

The single medication that costs Medicare the highest total amount overall is the blood thinner Eliquis (apixaban), with total spending reaching over $12 billion to $20 billion annually.

Highest Total Spending (Part D and Part B)

• Eliquis (apixaban): Costs Medicare the most in total aggregate Part D spending (used for preventing blood clots and strokes).
• Eylea: Tops Medicare Part B spending for provider-administered drugs, costing billions for macular degeneration treatments.

Highest Cost Per Patient / Per Claim

When looking at the highest cost per user or per prescription claim rather than total national spending:

• Specialty oncology and biologic drugs like ibrutinib (Imbruvica) and ustekinumab cost upwards of $110,000 to $130,000 per patient annually before recent price negotiations.
• Certain specialty generics like lenalidomide (a Revlimid generic for blood cancer) cost nearly $14,000 per single prescription fill, making it the most expensive generic burden on the system.

The best Medicare prescription drug plan depends on the specific medications you take and your local ZIP code, though national providers like Wellcare and Humana top industry ratings for affordability and value.

Top-Rated National Providers

• Wellcare: Recognized for low monthly premiums, with some stand-alone Part D plans starting at $0 per month.
• Humana: Highly rated for low out-of-pocket costs and strong benefits for managing chronic conditions like diabetes.
• UnitedHealthcare (AARP): Noted for high customer satisfaction and extensive nationwide availability.

Key Details to Consider

• The $2,100 Out-of-Pocket Cap: All Medicare Part D plans feature a yearly maximum out-of-pocket spending limit of $2,100 for covered drugs, after which your medications are free for the rest of the year.
• Insulin Savings: Out-of-pocket costs for covered insulin are capped at $35 per month under Medicare Part D.
• Formulary Match: A plan is only "best" if it covers the specific brand-name or generic drugs you currently take.

How to Find Your Best Plan

To see exact pricing and coverage for your prescriptions, use the official Medicare Plan Finder Tool to compare local options.

Medicare does not pay for over-the-counter medications, lifestyle drugs, or any drugs listed as excluded under national Medicare Part D Coverage Guidelines.

Excluded Drug Categories

By law, Medicare Part D and standard prescription plans cannot cover certain types of medications:

• Weight loss or weight gain: Medications used specifically for anorexia, weight loss, or weight gain (such as phentermine), though exceptions exist for specific medical wasting conditions.
• Cosmetic purposes: Drugs intended for hair growth (like Propecia) or cosmetic skin treatments.
• Sexual dysfunction: Medications used to treat erectile dysfunction (such as Viagra or Cialis).
• Fertility: Drugs that promote or enhance fertility.
• Cough and cold relief: Over-the-counter or prescription drugs solely for relieving common cold and cough symptoms.
• Vitamins and minerals: Prescription vitamins and mineral products (except for prenatal vitamins and fluoride preparations).
• Over-the-counter (OTC) drugs: Any medicine or product that does not require a prescription.
• Non-FDA-approved products: Medications not approved by the U.S. Food and Drug Administration (FDA) or deemed safe but not effective under DESI standards.

Other Coverage Gaps

• At-home outpatient drugs: Original Medicare (Parts A and B) generally does not cover most prescription drugs you take at home unless you enroll in a separate Medicare Part D Prescription Drug Plan.
• Off-formulary drugs: Individual plans maintain their own lists of covered medications (formularies). If a specific prescription is not on your plan's formulary and an exception is denied, the plan will not pay for it.