I'm choosing a plan
Will my medication cost more next year?
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It might. Plans can change their formulary (the covered-drug list) and drug tiers each year, with changes starting in January. Check each drug you take against next year's list before you choose a plan.
What to do
- List every medication you take: the exact name, strength and how often.
- Look up each one in next year's formulary and note its tier, the price group the drug sits in.
- Check for new limits: prior authorization (plan approval first), step therapy (trying a cheaper drug first) or quantity limits.
- Enter your drug list in the Medicare.gov Plan Finder, or the plan's own drug search, to compare yearly costs.
Ways to pay less, and other options
There are often cheaper ways to get the same treatment: a generic or a lower-tier drug that works the same way, a 90-day or mail-order supply (some plans charge less for it), the drug maker's assistance program, or Extra Help from Medicare if your income is limited.
It is also worth asking whether the medication is still the best fit. Every medicine can have side effects, and for some conditions changes in food, movement, sleep and daily habits can help, sometimes enough to need less of a drug or a different one. Ask your doctor: “What other ways can we find a solution for this?” Please don't stop or change a medication on your own.
What to say
Is [drug name, strength] on your formulary for next year, which tier is it on, and does it need prior authorization or step therapy?
Besides this medication, are there natural options, like changes in food, movement or a supplement, that could help with this diagnosis? Would any of them be safe with what I already take, and could they ever mean needing less of a drug?
Ask the plan the first question, and your doctor or pharmacist the second. Please don't stop or change a medication on your own.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Checking only whether a drug is covered, not which tier it is on. A drug can stay on the list and still move to a tier that costs you far more.
Better done together
We’re here to help
If a price jump or a side effect has you wondering what else is possible, we can help you prepare the questions for your doctor and your plan, and look at the options together.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
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The rule behind it
Medicare drug plans and Medicare Advantage plans send an Annual Notice of Change by September 30, listing the coverage and cost changes that start in January. Plans can also change their drug list during the year, but must tell you if a drug you take is affected. If a drug isn't covered or sits on a high tier, you or your doctor can ask for an exception, with a statement from your doctor. Medicare Part D caps what you pay out of pocket for covered drugs each year: $2,100 in 2026 and $2,400 in 2027.
Sources
- Medicare.gov — Plan Annual Notice of Change (ANOC)
- Medicare.gov — How do drug plans work?
- Medicare.gov — Drug plan rules
- Medicare.gov — Catastrophic coverage (yearly out-of-pocket cap)
- HealthCare.gov — Getting prescription medications (drug exceptions)
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
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