Epic will show cash drug prices. On Medicare, cash can miss the $2,400 cap

Part D drug costs stop at $2,400 out of pocket in 2027. A drug bought with a discount card instead of the Medicare plan doesn’t count toward that cap or the deductible, Medicare.gov says.

That rule matters more from summer 2027. Epic plans to release Prescription Marketplace then. The tool shows a drug’s insured price next to pharmacy cash prices before the doctor sends the prescription. Epic announced it on Oct. 15, 2026.

What Epic announced

Clinicians and patients at health systems that use Epic will compare what a drug costs at different pharmacies, with and without insurance, before the prescription goes out.

Amazon Pharmacy, Mark Cuban Cost Plus Drugs, Costco and Eli Lilly’s LillyDirect are working with Epic on the tool. Any pharmacy will be able to share its cash prices with health systems that use Epic.

Epic says its current insurance price tool for prescribers helped patients save more than $250 million in 2025. That is Epic’s own figure. Epic also says more than 40% of American adults report not taking their medicines as prescribed because of cost.

Mark Cuban, who cofounded Mark Cuban Cost Plus Drugs, gave Epic this example: “If someone’s insurance says a prescription costs $500 but they can buy the exact same drug for $100 at CostPlusDrugs.com, they should know that before they leave the doctor’s office.”

The cash price trap

For someone on Part D, the $100 price in that example has a catch. Medicare.gov says TrumpRx and other discount cards aren’t creditable coverage. When you use them instead of your Medicare plan, the purchase “doesn’t count toward your Medicare deductible or out-of-pocket maximum.”

CMS’s Part D manual has one narrow exception, in Chapter 14, section 50.4.2. A cash purchase counts toward the deductible and the cap only when all three of these are true:

• You buy a covered Part D drug at a pharmacy in your plan’s network.
• You are in a phase where you pay 100% of the drug’s cost. In 2027 that is the deductible, which CMS set at up to $700 for the standard benefit.
• You send your plan the receipt. CMS puts that job on the member.

Once the deductible is met, the exception ends. CMS writes that the policy “does not apply in any phase of an enrollee’s Part D benefit in which he or she is liable for any less than 100 percent cost-sharing.” CMS gives two reasons. The plan’s price is usually the lowest, and only a claim run through the plan gets the plan’s drug safety checks.

What isn’t known yet

Epic hasn’t said how Prescription Marketplace will handle Medicare Part D plans. It hasn’t said whether the tool will warn a Part D member that a cash purchase won’t count toward the cap.

Epic hasn’t named the health systems that will turn the tool on or published sample prices.

Why it matters

The $2,400 cap protects people with high drug bills. A cash price that looks cheaper at the doctor’s office can cost more over the year if those dollars don’t move the member toward the cap.

Medicare.gov tells members to compare discount prices with what they pay under their plan. Ask the pharmacy for both prices. If you pay cash during the deductible at a network pharmacy, send the receipt to your plan.