Medicare 2026

Part D Formularies and Drug Tiers: How to Check Your Drugs for 2027

Prescription drug coverage under Medicare runs through Part D, either as a stand-alone drug plan paired with Original Medicare or as part of a Medicare Advantage plan that includes drug coverage. The piece that matters most to your wallet is the plan's formulary — the list of covered drugs and the tiers they sit in. Before the plan year begins on January 1, 2027, it's worth taking a careful look at how your medications are covered.

What a formulary is — and why tiers matter

A Part D formulary is the plan's list of covered prescription drugs. Plans sort those drugs into tiers, and a lower tier generally costs you less than a higher one. A typical structure places preferred generics on the lowest tier, then non-preferred generics, preferred brand-name drugs, non-preferred brand drugs, and specialty drugs on the highest tier. The same medication can sit on different tiers in different plans, which is why two plans can have very different costs for the same prescription.

Plans can also apply utilization management rules to certain drugs:

• Prior authorization: the plan must approve coverage before you fill the prescription.
• Step therapy: you may need to try a lower-cost drug first before the plan covers a more expensive one.
• Quantity limits: the plan may cap how much of a drug you can get in a given period.

None of this means you can't get the medicine — it means there may be an extra step.

Checking your drugs for 2027

Here's a straightforward way to review coverage before and during the Annual Enrollment Period (October 15 – December 7, 2026):

1. Make a current list of every prescription you take, including the exact name, dose, and how often you fill it. 2. Read the Annual Notice of Change (ANOC). If you're already in a Part D or Medicare Advantage drug plan, your plan must send you an ANOC each fall. It spells out what's changing for the next year — including formulary changes, tier changes, and new utilization rules. 3. Use the Plan Finder tool on Medicare.gov to enter your drugs and preferred pharmacies and see how each plan would cover them in 2027. 4. Look beyond the premium. Check the tier your drug sits on, the deductible, the cost-sharing at your pharmacy, and whether prior authorization, step therapy, or quantity limits apply. 5. Call 1-800-MEDICARE if you want help walking through options.

Program-level numbers to know for 2027

A few national Part D figures are already set for 2027:

• The Part D out-of-pocket cap is $2,400 in 2027 (up from $2,100 in 2026). Once your out-of-pocket spending on covered drugs reaches that cap, you pay nothing more for covered Part D drugs the rest of the year.
• The maximum deductible any Part D plan may charge is $700 in 2027. Plans can charge less.
• The Part D base beneficiary premium for 2027 is $41.33. This is a national figure used in calculating the late-enrollment penalty; actual plan premiums are set plan by plan.
• Social Security announced on October 14, 2026 a 3.6 percent cost-of-living adjustment (COLA) for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets and surcharges, had not been announced at the time of writing. CMS typically announces them in the fall, usually in November. Check Medicare.gov for the official figures.

If a drug isn't covered: exceptions and transitions

If a drug you take isn't on a plan's formulary — or it's on a tier that makes it unaffordable, or a utilization rule stands in the way — you can ask the plan for an exception. Your prescriber generally needs to support the request with a statement explaining why the drug is medically necessary. Plans must have a process for this and for appeals if the request is denied.

If you're new to a plan and already taking a drug that isn't on the new plan's formulary (or is subject to restrictions), you can usually get a transition supply — a temporary fill — while you work with your prescriber to switch medications or file an exception request.

Original Medicare + stand-alone Part D vs. Medicare Advantage with drug coverage

Both paths include Part D drug coverage, and both have trade-offs. Original Medicare paired with a stand-alone Part D plan (often with a Medigap supplement) lets you choose your drug plan separately from your medical coverage and generally gives you broad provider access, but you pay separate premiums and Medigap doesn't cover drugs. Medicare Advantage plans often bundle medical and drug coverage with extra benefits, usually through provider networks and plan-specific rules. Neither option is "better" — it depends on your drugs, your doctors, and how you prefer to manage coverage.

Special rules if you have Medicaid or Extra Help

If you have full Medicaid or qualify for Extra Help (the Low-Income Subsidy), you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch from one stand-alone Part D plan to another. If you are a full-benefit dual-eligible, you can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month. These flexibilities mean you don't have to wait for the fall to make a change.

Where to go next

For official rules, plan comparisons, and the 2027 figures as they're released, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, available 24/7.

This article is for general educational purposes only and is not affiliated with any government agency.