Medicare Changes Coming in 2027 Could Cut Drug Costs for Kidney Patients—Here's What You Need to Know

Starting in 2027, Medicare is proposing significant changes to how prescription drug coverage works that could lower costs for people living with chronic kidney disease (CKD), end-stage renal disease (ESRD), and kidney transplant recipients. The Centers for Medicare & Medicaid Services (CMS) has put forward reforms aimed at making medications more affordable, but kidney health advocates are raising important concerns about how these changes could affect real patients.

What Specific Medicare Drug Changes Are Coming in 2027?

The National Kidney Foundation (NKF) submitted detailed comments on the proposed 2027 Medicare changes, supporting several reforms designed to ease the financial burden of prescription medications. For kidney patients who depend on multiple medications to survive and thrive, these changes could make a meaningful difference in their daily lives.

The proposed changes include:

• Eliminating the Medicare Part D coverage gap: This "donut hole" currently forces patients to pay more out-of-pocket for medications during a specific coverage phase, which can be devastating for people managing complex conditions like kidney disease.
• Reducing annual out-of-pocket spending limits: Lower caps on what patients must pay each year would make medication costs more predictable and manageable for those on fixed incomes.
• Removing cost-sharing in the catastrophic phase of coverage: This means patients wouldn't face additional charges once they've spent a certain amount on medications, protecting them from unexpected financial crises.

For kidney patients specifically, these reforms matter because they rely on life-sustaining medications including immunosuppressants after transplant and drugs that manage complications of CKD. Without affordable access to these medications, patients face serious health risks.

Why Are Kidney Advocates Worried About These Changes?

While the NKF supports the proposed cost reductions, the organization raised a critical concern: some Medicare Advantage and Part D plans might offset their new costs by narrowing drug formularies (the list of covered medications), adding utilization management tools that delay access, or restricting pharmacy networks. For transplant recipients and people on dialysis, even short delays in medication access can lead to serious health complications or treatment failure.

"Affordability reforms must not come at the expense of access to medically necessary drugs," the NKF emphasized in its comments to CMS. This means that while lower prices are important, patients also need to actually be able to get their medications without jumping through bureaucratic hoops.

How Will These Changes Affect Your Medicare Plan Choices?

Beyond drug costs, CMS is also proposing changes to how Medicare Advantage plans are rated and how flexible they are when problems arise. These changes could significantly impact kidney patients' ability to access the specialized care they need.

The NKF is advocating for several protections:

• Stronger quality measures: Medicare Advantage plans should be rated on outcomes that matter to kidney patients, such as care coordination in Special Needs Plans (SNPs), member experience, and patient satisfaction—not just administrative processes.
• Clear, plain-language communication: Changes to Medicare coverage can be confusing, especially for people managing complex chronic conditions. If beneficiaries don't understand how their coverage is changing, they may delay refilling prescriptions or skip medications entirely, increasing the risk of hospitalization or transplant complications.
• Greater flexibility to switch plans: People with end-stage renal disease (ESRD) should be able to change Medicare Advantage plans outside the annual enrollment period if they discover mid-year that their plan doesn't adequately cover their dialysis provider, transplant center, or specialized kidney services.

The ability to change plans when access issues arise can protect continuity of care, prevent treatment disruptions, and reduce financial strain on patients and families.

What Should Kidney Patients Do Right Now?

These proposed changes are still in the comment period, meaning there's an opportunity for patients and advocates to shape how they're implemented. The NKF is urging kidney patients and their families to make their voices heard by joining advocacy efforts and contacting lawmakers about policies that improve care, affordability, and access.

If you or someone you love lives with kidney disease, understanding how Medicare changes could affect your coverage is essential. Pay attention to any notices from your Medicare plan about 2027 changes, and don't hesitate to reach out to patient advocacy organizations like the NKF for help navigating your options. The goal of these reforms should be making kidney care more affordable without sacrificing the access to medications and specialists that keep kidney patients healthy.