Medicare Part D

Part D Formulary Changes for 2027 — Laurel, MD

# Your Part D drug got a green light this year. Will it in…

LAUREL, Md. — The envelopes are landing in mailboxes across Prince George's County right now. If you have a Medicare Part D plan or a Medicare Advantage plan with drug coverage, the Annual Notice of Change (ANOC) that arrived in late September is the single most important piece of mail you will get all fall. It tells you, in plain language, what is changing about your plan on January 1 — including whether the medications you take will still be covered the same way.

With the Annual Enrollment Period running October 15 through December 7, this is the window to catch surprises before they become problems at the pharmacy counter.

What actually changes on a Part D drug list

Every Part D plan has a formulary — the list of drugs it covers. That list is not frozen. Plans update it each year, and here is what can shift:

• Tier changes. Most plans sort drugs into tiers (generics on lower tiers, brand-names and specialty drugs on higher ones). A drug you take can move up or down a tier, which changes your share of the cost.
• Prior authorization (PA). Your plan may now require your doctor to submit paperwork explaining why you need the drug before it will be covered.
• Step therapy. The plan may require you to try a lower-cost drug first before it will pay for the one you are on.
• Quantity limits. The plan may cap how much you can get in a given time period — say, 30 pills a month instead of 60.
• Removal. Occasionally a drug is dropped entirely, though generic substitutions and safety recalls are the more common reasons.

These tools are called utilization management. They are legal and common — the point of reading the ANOC is to find out if any of them now apply to a drug you take.

How to actually read the ANOC

The ANOC is not short, but you do not need to read every page. Head straight to these parts:

1. The premium and deductible section. Note any dollar changes for 2027. 2. The drug coverage section. Look for a summary of formulary changes. Then check the drug list itself for each medication you take by name. 3. The utilization management column. This is where "PA," "ST," or "QL" will appear next to a drug. If one of those letters is new next to your medication, that is your flag. 4. The pharmacy network section. Your preferred pharmacy could change status.

If you cannot find your ANOC, call your plan and ask them to resend it, or log in to your plan's member portal.

What's set by Medicare for Part D in 2026 and 2027

Some things are set by Medicare itself, not your specific plan:

• The out-of-pocket cap for covered drugs is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing for covered drugs the rest of the year.
• The maximum deductible any Part D plan can charge is $615 in 2026 and $700 in 2027.
• The old "donut hole" coverage gap no longer exists. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug costs into monthly installments across the year instead of paying big amounts at the pharmacy. It is optional and free to opt into.
• IRMAA surcharges on Part D premiums start above $109,000 in income for a single filer in 2026.

If a drug you take is affected, here are your moves

You have real options, and you do not need to panic:

• Talk to your prescriber. Sometimes a therapeutic alternative on a lower tier works just as well. Sometimes your doctor can submit the prior authorization quickly.
• Compare plans during AEP (Oct. 15 – Dec. 7). The Medicare Plan Finder at medicare.gov lets you enter your exact drug list and see how each plan in your area would cover them. Laurel is in Prince George's County, where Marylanders generally have a broad set of stand-alone Part D and Medicare Advantage options to compare.
• Ask about an exception. You (or your doctor) can request a formulary exception or a tiering exception if the standard rule does not fit your situation.
• Use the transition fill. If you stay in the same plan and a drug you already take suddenly needs PA or step therapy in January, plans generally must give you a temporary one-time supply while you and your doctor sort it out. Do not skip doses — call the plan.
• Remember Medicare Advantage Open Enrollment (Jan. 1 – Mar. 31). If you are in a Medicare Advantage plan and things are not working, you get one more chance to switch.

Where to get help you can trust

Personalized questions deserve personalized answers — from someone with no sales stake in your decision:

• medicare.gov — the official Plan Finder and formulary lookup.
• 1-800-MEDICARE (1-800-633-4227) — 24/7, free.
• Maryland SHIP (SHIP is the State Health Insurance Assistance Program) — free, unbiased one-on-one counseling for Marylanders. Prince George's County residents can be connected to a local counselor.