Medicare Part D

Ankeny Medicare: why your Part D drug can change on Jan. 1, and where the ANOC spells it out

ANKENY, Iowa — The envelope that lands in Polk County mailboxes every fall is easy to set aside, but it is the one piece of Medicare mail worth reading cover to cover. It is called the Annual Notice of Change, or ANOC, and it tells you exactly how your Part D drug coverage will look different on January 1 — including whether a medicine you have taken for years will sit on a new tier, require prior approval, or come with a new quantity limit.

Plans finalize those changes for the coming year and send the ANOC by late September. From there, the Annual Enrollment Period runs October 15 through December 7, which is your window to switch if the new rules do not fit.

Why a covered drug can change from one year to the next

Part D plans are required to cover a broad range of drugs, but each plan builds its own formulary — the list of drugs it covers and the rules attached to them. Every year, plans update that list. Drugs can move to a different tier, pick up new utilization management, or come off the formulary entirely. New generics and biosimilars can also change how a plan handles a brand-name medicine.

None of that means your plan is doing something wrong. It means the rules you knew last year may not be the rules that apply on January 1.

Tiers, in plain English

Most Part D formularies use tiers to group drugs by cost-sharing level. A typical structure looks like this:

• Tier 1 – Preferred generic
• Tier 2 – Generic
• Tier 3 – Preferred brand
• Tier 4 – Non-preferred drug
• Tier 5 – Specialty

The higher the tier, the more you generally pay at the pharmacy. If your medication moves from Tier 2 to Tier 3, the drug itself has not changed — but your share of the cost may.

The four utilization management tools to watch

When you read your ANOC, four terms come up again and again:

• Prior authorization (PA): Your doctor has to get the plan's okay before the prescription is covered.
• Step therapy (ST): You must try a lower-cost or preferred drug first. If it does not work, the plan will consider the next option.
• Quantity limits (QL): The plan caps how much of a drug it will cover in a given period — for example, a set number of pills per month.
• Non-formulary: The drug is no longer on the plan's list. You can request an exception, switch drugs, or switch plans.

These tools are not new, but which drugs they apply to changes every year. That is what the ANOC is telling you.

How to read your ANOC without losing an afternoon

The ANOC is a side-by-side: this year versus next year. A few pages usually do most of the work.

1. Find the drug list changes section. Look for each of your regular prescriptions by name. Note the current tier, next year's tier, and any PA, ST, or QL flags. 2. Check the premium, deductible, and pharmacy cost-sharing pages. These change every year too. 3. Confirm your pharmacy is still preferred. In-network is not the same as preferred, and the difference shows up at the register. 4. Look at the mail-order rules if you use a 90-day supply.

If something looks off, call the plan's member services line — the number is on the back of your card — and ask them to walk through it with you.

What changes in 2026 that applies to every Part D plan

A few program-level rules apply no matter which plan you have:

• The Part D out-of-pocket cap is $2,100 in 2026. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $615 (plans can charge less).
• The coverage gap ("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 drug costs across the calendar year in monthly bills instead of paying at the pharmacy counter. It is optional and free to opt into.
• IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.

If you are mid-therapy on January 1

New Part D enrollees, and people whose drug is newly restricted by their plan, are generally entitled to a transition fill — a temporary supply (usually at least a month) of a drug that is not on the new formulary or now has restrictions. That gives you time to work with your doctor on an exception request or a switch. Ask your plan how their transition policy works before you run out.

Ankeny is in Polk County — here is what that means for choices

Medicare plan availability is set at the county level. Ankeny is in Polk County, where residents typically have a mix of stand-alone Part D drug plans and Medicare Advantage plans that include Part D. If the ANOC changes do not work for you, the Annual Enrollment Period (Oct. 15 – Dec. 7) is when you can switch. If you are in a Medicare Advantage plan, there is also the Medicare Advantage Open Enrollment Period from January 1 to March 31 to make one change.