First Time on Medicare: New Beneficiary Guide
Your 65th birthday is a deadline, not just a milestone. Three months before, start learning Medicare, enroll in Part B and D, and choose a plan. Late moves cost you.
Medicare Part D Formulary Changes During AEP
Every January 1, your Part D plan's drug formulary (the list of covered drugs) may change. Dosage, tier, copay, or coverage status can shift. Check your prescriptions during AEP.
What changes on formularies
From year to year, a drug might be added, removed, moved to a higher cost tier (copay increase), or require prior authorization or step therapy. A drug you pay $15 for in 2026 might jump to $50 or need approval before it's dispensed.
Generics might replace name brands, and coverage tiers can reshuffle. No single reason — it's a combination of clinical decisions, pricing, and plan strategy.
How to check your drugs
Use Medicare.gov's plan comparison tool. Enter each medication you take, and the tool shows which plans cover it, at what tier, and what you'll pay annually.
Alternatively, visit each plan's website, call the plan directly, or work with a pharmacy to check before you enroll. Don't assume 2026 coverage matches 2025.
If your drug is removed or costs too much
If your current plan removes a drug or moves it to a higher tier, consider switching plans during AEP. A $5 drug becoming $100 might justify paying slightly more in premiums for a plan that covers it affordably.
If you switch plans and a drug is excluded or too expensive in the new plan, you may request a coverage exception or therapeutic substitution from your plan.
What to do before December 7
Pull together your current medications — names, dosages, frequency. Enter each into Medicare's tool. Compare plans by total annual costs, not just premiums.
Confirm your mail-order pharmacy is in-network if you use one; mail-order drug pricing differs from retail.
Frequently asked questions
Why was my drug removed from my plan's formulary?
Plans regularly update their formularies based on clinical data, costs, and coverage decisions. No single reason. Contact your plan to ask about alternatives or exceptions.
Can I ask for an exception to get my drug covered?
Yes, you can request a formulary exception from your plan. It's reviewed by the plan's pharmacy team and requires a doctor's supporting statement.
What if I switch plans and the new one doesn't cover my drug?
Once enrolled, you can request an exception or ask about therapeutic alternatives (similar drugs on their formulary). If needed, you can switch again in the next AEP.
Do all Part D plans have the same drugs?
No. Each plan sets its own formulary. The same drug may be covered differently (or not at all) across plans in your area.
General educational information only, not medical or pharmaceutical advice. Part D formularies change annually and vary by plan. Always verify current coverage with the specific plan before enrolling.
Related articles
Changing Doctors and Networks During AEP
Doctor networks can shift year to year. Before AEP ends, verify your doctors are in-network for your 2026 plan, or switch to one where they are.
Medicare Preventive Services: What's Free
Medicare covers many preventive services with no copay: screenings, vaccines, annual physicals. Take advantage of these free benefits to catch problems early.