Standalone Medicare Part D plans provide vital prescription drug coverage to beneficiaries, but the medications available — and their costs — may change from year to year. Your plan’s formulary may add, remove, or change preferred medications, which can leave lasting effects on your health and budget.

An easy way to know if Medicare Part D formulary changes will impact you is to review your Annual Notice of Changes (ANOC). Your plan provider sends this document by September 30 each year, outlining any changes that will take effect the following January. It details any prescription coverage changes, including the name of the medication, the reason for the change, and alternative drugs available. 

It’s important to review your formulary changes each year to ensure your plan continues covering the medications you need. Keep reading to learn why Part D drug lists change and how to review your plan’s formulary to ensure you’ll be fully covered in 2026.

Why do Medicare Part D formularies change each year?

Private carriers provide Medicare Part D, and each generates its own formulary. Every year, they decide which medications they will cover and their associated cost tiers. Many factors impact yearly coverage decisions, including:

• The cost of existing prescription drugs may change
• New medications become available
• A lower-cost generic or biosimilar medication entering the market
• Insurers negotiate a better price with certain drug manufacturers (changing their preferred drug brands or drug tiers)
• Drugs are removed from the market
• New restrictions by the manufacturer or the FDA
• Changing treatment guidelines

As a result of these factors, it’s common for Part D drug lists to change each year. The best way to maintain uninterrupted drug coverage with no surprise expenses is to check your plan’s formulary each year during Open Enrollment.

How to check your Medicare Part D plan’s formulary 

Although every insurance carrier is different, they all typically have a full formulary available through their website, and many offer an easily searchable database. Follow the step-by-step guide below to check your plan’s drug coverage for next year. 

Step 1: Note your prescriptions and visit your Plan D website

You’ll first need to make a list of all your medications and dosages. Then, visit your Medicare Part D insurance carrier’s website. To access your plan’s prescription drug information, you may need to create an account with your carrier or log in to your existing Medicare Part D account. 

Step 2: Search for your medications

Once you’re logged into your account, locate the drug formulary, which may be labeled as “drug list,” “formulary,” or “covered medications.” Depending on your carrier, you can access a full alphabetical drug list, a searchable database, or both. If using the searchable database, you will need to type the brand name or generic drug you’re looking for in the search bar.

Step 3: Confirm your coverage and look for changes

After you confirm the medication is in the formulary, make sure to review:

• The dosages covered
• If the drug tier has changed
• Your co-pay or co-insurance costs for next year
• If there are new requirements like prior authorization, step therapy, or quantity limits before you can access the drug

If your medication doesn’t appear on next year’s formulary or you have concerns about changing costs or availability, you can always contact your healthcare provider for alternatives or look at other Medicare Part D plans. 

How your Medicare Part D formulary impacts your deductible and out-of-pocket max

For your prescription drug costs to count towards your Part D deductible and annual out-of-pocket max — up to $615 and $2,100 in 2026, depending on your plan — the medications must be covered in your plan’s formulary. If a medication is removed from the drug list, it will no longer count towards those healthcare expenses. That could mean paying full price for the drug instead of your typical co-pay, and leave you with higher medication expenses for the year overall. 

There is one exception: if your doctor prescribes a medication that isn’t in your plan’s formulary, you can request an appeal for coverage. If your carrier approves the appeal, your drug costs will count toward your deductible and out-of-pocket max. However, the appeal process can be time-consuming, so you may be better served by choosing a plan that already covers your medications.

Protect your prescription drug coverage in 2026

Changes to Part D drug lists and costs make it necessary to check your medications against your plan’s formulary each year. Ensuring continued coverage of all your prescriptions is not only key to maintaining your health, but it also helps keep costs down. If you have questions about Medicare Part D formulary changes or need help evaluating plans, speak with one of our licensed insurance agents.

*Disclaimer:

The information provided in this blog post is intended for general informational purposes only and does not constitute medical advice. It is not a substitute for professional medical consultation or treatment. Always consult with a qualified healthcare provider for any questions you may have regarding a medical condition.

SmartMatch does not endorse or recommend any specific products, treatments, or procedures mentioned in this article. Reliance on any information provided in this blog post is solely at your own risk. We encourage you to discuss any health concerns or questions with your doctor before making any decisions about your health or treatment.