What Medicare Drug and Plan Changes Mean for Kidney Disease Care in 2027

Medicare Advantage and Medicare Part D play a major role in how many people with kidney disease get their care and medications. For patients living with chronic kidney disease (CKD), end-stage renal disease (ESRD), or a kidney transplant, plan design choices, like drug coverage, provider networks, and out-of-pocket costs, can have a big impact on daily life.

Read NKF's comment letter. 

NKF supports several proposed changes to Medicare Part D that aim to lower prescription drug costs for people living with chronic kidney disease (CKD), end-stage renal disease (ESRD), and kidney transplants.

The Centers for Medicare & Medicaid Services (CMS) has proposed:

• Eliminating the Medicare Part D coverage gap
• Reducing annual out-of-pocket spending limits
• Removing cost-sharing in the catastrophic phase of coverage

For kidney patients who rely on life-sustaining medications, including immunosuppressants after transplant and drugs that manage complications of CKD, these reforms could make prescription costs more predictable and affordable.

NKF also urged CMS to closely monitor how Medicare Advantage and Part D plans respond to these changes. There is concern that some plans could offset new costs by narrowing drug formularies, adding utilization management tools, or restricting pharmacy networks.

For transplant recipients and people on dialysis, even short delays in medication access can lead to serious health complications. Affordability reforms must not come at the expense of access to medically necessary drugs.

Changes to Medicare drug coverage and benefits can be confusing, especially for people managing complex chronic conditions like kidney disease.

NKF emphasized the need for:

• Clear, plain-language communication
• Timely notices about coverage changes
• Culturally and linguistically appropriate information

If Medicare beneficiaries do not understand how their Medicare Advantage or Part D coverage is changing, they may delay refilling prescriptions or skip medications entirely, increasing the risk of hospitalization or transplant complications.

Clear communication helps patients compare plans, understand their out-of-pocket costs, and make informed decisions about their kidney care coverage.

NKF supports CMS efforts to strengthen Medicare Advantage quality ratings so they reflect outcomes that truly matter to patients, not just administrative processes.

However, we raised concerns about removing certain quality measures that are especially important for people with CKD, ESRD, and complex medical needs.

In particular, measures related to:

• Care coordination in Special Needs Plans (SNPs)
• Member experience and patient satisfaction

These indicators help kidney patients determine whether a Medicare Advantage plan can effectively coordinate dialysis care, transplant services, specialist visits, and medication management.

Removing these measures could make it harder for beneficiaries to compare Medicare plans and select one that supports high-quality kidney disease care.

NKF supports proposals that would give Medicare beneficiaries more flexibility to switch plans outside of the annual enrollment period.

This flexibility is especially important for people with end-stage renal disease (ESRD) who may discover mid-year that their Medicare Advantage plan does not adequately cover:

• Their dialysis provider
• Their transplant center
• Specialized kidney services

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

Medicare Advantage and Medicare Part D can provide important benefits for people living with kidney disease — but only if drug coverage, quality ratings, and plan rules work in real-world patient situations.

NKF will continue advocating for Medicare policies that promote:

• Affordable prescription drug coverage
• Transparent plan information
• Strong quality standards
• Reliable access to dialysis and transplant care

We'll also continue fighting to protect access to high-quality kidney care remains at the center of Medicare reform discussions.

If you or someone you love lives with kidney disease, your story matters. Join Voices for Kidney Health to receive alerts, contact lawmakers, and advocate for policies that improve care, affordability, and access.