Medicare Part D

Your Part D drug list can change Jan. 1 — read the ANOC

ATLANTA — The mail is about to get heavier. Every fall, Medicare Part D plans send out an Annual Notice of Change (ANOC), and buried inside is information that can quietly reshape what you pay for your prescriptions starting January 1. A drug you filled all year at a low tier might move to a higher one. A medication you've taken for years might suddenly require prior authorization. This is normal — and it's exactly why the fall Annual Enrollment Period, running October 15 through December 7, exists.

Atlanta is in Fulton County, where Medicare beneficiaries have a wide range of stand-alone Part D and Medicare Advantage plans that include drug coverage. But no matter which plan you have, the rules about how drug lists (formularies) can change from one year to the next are the same.

What actually changes between plan years

A Part D plan's formulary is the list of drugs it covers, and it isn't fixed forever. Each year, plans can:

• Add or drop drugs from the covered list.
• Move drugs between tiers. Most plans use a tier system (often five or six tiers), where lower tiers usually mean lower cost sharing and higher tiers usually mean higher cost sharing. A drug moving from Tier 2 to Tier 4 can change what you pay at the pharmacy counter.
• Add utilization management rules — the tools plans use to control how a drug is prescribed and dispensed.

Those utilization rules are worth knowing by name, because they show up in the ANOC as small footnotes that can have big consequences.

Prior authorization, step therapy, and quantity limits — plain English

Prior authorization (PA): Before the plan will cover the drug, your doctor has to submit paperwork showing why you need it. Without approval, the pharmacy claim is rejected.

Step therapy: The plan asks you to try a lower-cost or preferred drug first. Only if that doesn't work will the plan cover the drug your doctor originally prescribed.

Quantity limits (QL): The plan will only cover a certain amount over a certain period — for example, a set number of pills per month.

None of these are new for 2027, but plans can add, remove, or tighten them each year. A drug you filled easily in November could hit a PA requirement in January.

How to read your Annual Notice of Change

The ANOC is required by CMS and arrives by late September. Set aside 20 minutes and look specifically for:

• The formulary change section. Are any of your current drugs no longer covered?
• Tier changes. Has anything you take shifted up (or down) a tier?
• New restrictions. Look for the letters "PA," "ST," or "QL" next to your medications.
• Premium and deductible changes. These are separate from drug list changes but matter to your total cost.

If your plan still fits, you don't have to do anything — your coverage renews automatically. If it doesn't, you have until December 7 to switch during Annual Enrollment. Those on Medicare Advantage also have a second window, January 1 through March 31, to change Advantage plans.

What if your drug is dropped mid-year

Plans can make certain formulary changes during the year, but they must generally give affected members notice. If you're new to a plan or your drug is newly restricted, ask your pharmacist and plan about a transition fill — a one-time temporary supply (typically about a month) that gives you time to work with your doctor on an exception request, a switch to a covered alternative, or a formal appeal.

You always have the right to request a coverage determination or formulary exception from your plan, and to appeal a denial.

The 2027 backdrop

Some big-picture changes are worth keeping in mind as you compare the fine print:

• The Part D out-of-pocket cap is $2,400 in 2027 (up from $2,100 in 2026). Once your covered drug spending hits that ceiling, you pay nothing for covered drugs the rest of the year.
• The maximum Part D deductible is $700 in 2027, up from $615 in 2026 (plans can set theirs lower).
• The coverage gap — the old "donut hole" — is gone as of 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across monthly installments instead of paying big amounts at the pharmacy. It's optional and you have to opt in.
• IRMAA surcharges on Part D and Part B start above $109,000 in income for a single filer in 2026.

Where Atlanta readers can get help

Comparing formularies drug by drug is tedious but doable. A few free, unbiased places to start:

• Medicare.gov Plan Finder lets you enter your medications and pharmacy to see how each available plan would handle them.
• 1-800-MEDICARE (1-800-633-4227) is staffed 24/7.
• Georgia's SHIP program, called GeorgiaCares, offers free one-on-one Medicare counseling to Fulton County and metro Atlanta residents through the Division of Aging Services.