Prescription drugs expected to become less affordable in 2026 when ACA tax subsidies expire

MILWAUKEE (CBS 58) -- With Affordable Care Act tax subsidies set to expire at the end of the year, average insurance premiums in Wisconsin will cost more than $500 more next year.

That amounts to more than $6,000 more a year.

The fear is millions of Americans will drop their insurance if they cannot afford it. And that could make the cost of prescription drugs shoot up even more.

Dr. Hashim Zaibak is the founder of Hayat Pharmacy. He told us, "When the copay is high, they skip doses because they cannot afford it."

And that happens even when people have insurance.

But Zaibak warns without insurance coverage at all, out-of-pocket costs for many medications could be simply impossible.

More than 310,000 Wisconsinites have insurance through the Affordable Care Act.

Without the tax credits, premiums will soar by an average of $520 a month in 2026.

If people can't afford those increases, industry leaders say they'll simply go without insurance.

Dr. Zaibak said, "I know some friends who are actually -- they've already decided to go without insurance in 2026 because the cost is high and there is no help from the government to get those premiums down."

Zaibak showed how the cost of several medications is affected when covered by insurance.

Paxlovid treats Covid infections. With insurance, it costs just a few dollars or sometimes nothing at all. "But," Zaibak said, "if the patient does not have insurance, it's going to cost them over $1,000."

Generic medications are often a good option for many patients.

Zaibak said, "It comes in a generic. It's been in the market for a while, so even if the person does not have insurance, they can get it for a good price."

But the challenge is with brand name medications or new medications where a generic version is not yet available.

Zaibak said, "It can be the difference between $20 with a copay and $1,200 for medication that's very expensive, yes."

And it's not just ACA costs that are increasing. The cost of employer-sponsored health insurance is also expected to rise in 2026, by an average of 6.7%, according to a study by Mercer.

Which means a lot of people will be facing higher costs.

Zaibak said, "So sometimes they have to choose between putting food on the table or putting medication on the table, and sometimes it's a hard choice."

He recommends people talk with their doctor and pharmacist to see if there are generic alternatives to medications you may not be able to afford.

Even if there's not a direct replacement, there may be ways to substitute cheaper medications to try to get the benefits of a more expensive one.

We did ask if there was a way to stock up on medication before the costs increase. Most insurers don't allow for more than one month of medication at a time, but sometimes you can get three months.

But that's not an option for controlled medications like those for pain management.