Medicare Part D

Same drug, different rules in 2026: how to read the ANOC before it lands in Olathe mailboxes

Olathe, Kan. — Every fall, a plain-looking envelope shows up in mailboxes across Johnson County. Inside is the Annual Notice of Change, or ANOC, a document your Medicare drug or Medicare Advantage plan is required to send by late September. It spells out what will be different about your coverage on January 1 — and for anyone who takes a regular prescription, it is the single most important piece of Medicare mail you will get all year.

The reason is simple: the drug you filled without a hitch in 2025 may sit on a different tier in 2026, or need prior authorization it did not need before, or come with a new quantity limit. The medication has not changed. The rules around it have.

What the ANOC actually is

The Annual Notice of Change is a side-by-side comparison your plan writes for you: this is what your coverage looked like this year, and this is what it will look like next year. It covers premiums, the deductible, cost-sharing, the pharmacy network, and — the part that trips people up — the formulary, which is the plan's list of covered drugs.

Plans are allowed to update their formularies every year. Medicare reviews those changes, but the plan still gets to decide how it groups drugs, what hoops it puts around them, and which pharmacies count as preferred.

If you take even one prescription regularly, the ANOC is worth twenty minutes at the kitchen table. Have your pill bottles nearby.

Tiers: the same drug, a different shelf

Most Part D plans sort covered drugs into tiers — usually five. Lower tiers tend to be generics and preferred brands; higher tiers are non-preferred brands and specialty medications. Your share of the cost depends on which tier your drug sits on.

Here is where the ANOC matters: a drug can stay covered but move from a lower tier to a higher one. Nothing about the medicine changed. What changed is how the plan is pricing it. That is why "still covered" and "still affordable for you" are not the same sentence.

Prior authorization, quantity limits, and step therapy

These three tools are called utilization management. Plans use them to control cost and, they argue, to encourage safer prescribing. In practice, they can mean your pharmacist tells you the refill you have gotten for two years is suddenly on hold.

• Prior authorization means your doctor has to get the plan's approval before it will cover the drug. This can be added to a drug that did not require it before.
• Quantity limits cap how much of a drug the plan will cover in a given time — say, 30 tablets a month instead of 60.
• Step therapy means the plan wants you to try a preferred (usually cheaper) drug first. Only if that does not work will it cover the one your doctor originally prescribed.

Any of these can be added at the start of a new plan year. The ANOC is where you find out.

The 2026 numbers worth knowing

A few program-level facts apply no matter which plan you are in:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your spending on covered drugs hits that ceiling, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible a plan can charge is $615. Plans can charge less; they cannot charge more.
• The old coverage gap — the "donut hole" — is gone. As of 2025, Part D has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug costs across monthly payments instead of paying at the pharmacy counter. It does not lower the total; it smooths it out. You have to opt in.
• Higher-income enrollees pay an IRMAA surcharge on Part D; for a single filer in 2026, that begins above $109,000 in income.

How to actually read your ANOC

Open it with your medication list in hand and walk through it in this order:

1. Find the formulary change section. Look up each drug you take. Note the tier for next year and compare it to this year. 2. Look for the letters "PA," "QL," or "ST" next to your drugs. Those flags mean prior authorization, quantity limit, or step therapy. If any of them are new, circle it. 3. Check the pharmacy network. A pharmacy that was "preferred" this year might not be next year, and that can change your cost even if the drug itself did not change. 4. Read the premium and deductible lines. These are stated plainly in the ANOC. 5. If something looks off, act during AEP. October 15 through December 7 is when you can switch to a different Part D or Medicare Advantage plan for the coming year.

If you miss AEP and you are in a Medicare Advantage plan, you have one more window — Medicare Advantage Open Enrollment, January 1 through March 31 — to make a one-time change.

What if the plan changes a drug mid-year?

Plans can, in some cases, make formulary changes during the plan year, following Medicare's rules and notice requirements. If your drug is affected, you generally have a right to a transition fill — typically a one-time supply — when you first join a plan or when a change hits, so you and your doctor have time to react. You can also ask for an exception if your prescriber believes the covered alternative will not work for you. The ANOC and your plan's Evidence of Coverage explain how to file one.

Olathe residents: where to get unbiased help

Olathe is in Johnson County, and like every county in Kansas it has a substantial menu of stand-alone Part D and Medicare Advantage options each year. The number of plans is not the same as the number of good fits for your prescription list. That comparison has to be done drug by drug.

For personalized help, three resources are free and independent of any insurance company:

• Medicare.gov's Plan Finder lets you enter your drugs and pharmacies and see how each available plan would handle them next year.
• 1-800-MEDICARE (1-800-633-4227) is staffed 24/7.
• SHICK, Kansas's State Health Insurance Assistance Program, provides free one-on-one counseling from trained volunteers who do not sell insurance.