@irenea8 My understanding, at least through 2026, is that Brinsupri is a prior authorization (exception) medication, whether you're on Medicare (Part D) or private insurance. I believe it falls under the catastrophic coverage category and counts towards the out-of-pocket maximum of your particular drug plan. As you mentioned there's a $2,100 out-of-pocket cap for 2026 for Part D. Any co-pay you make will go towards that OOP max for Medicare or private insurance. How much your "co-pay" for Brinsupri is depends on your drug plan and household income. Once you reach the OOP max you will pay zero dollars for subsequent medications for 2026.