Medicare Part D

Binghamton Part D checkup: how to read the 2027 Annual Notice of Change before it changes your refill

BINGHAMTON, N.Y. — Sometime this fall, most people in Broome County who have a Medicare Part D drug plan or a Medicare Advantage plan with drug coverage will find a thick envelope in the mailbox. Inside is the Annual Notice of Change, or ANOC — the document that tells you exactly how your plan will look different on January 1, 2027. It is easy to set aside. It is also the single most useful piece of paper you will get all year if you take prescription drugs.

The ANOC matters because a Part D plan's drug list (called a formulary) is not fixed. Tiers can shift, rules like prior authorization or step therapy can be added, and quantity limits can tighten. A medication that filled easily in 2026 can come with new hoops in 2027 — even if you stay in the same plan.

Here is how to read the notice, and what to do if something on your list is changing.

What the ANOC actually is

The ANOC is a plain-language summary, required by the Centers for Medicare & Medicaid Services (CMS), of everything that is changing in your plan next year compared to this year. Plans must send it so it arrives by September 30. It covers:

• Monthly premium and deductible changes
• Copay and coinsurance changes
• Changes to the drug list, including tier moves
• New or removed utilization management rules (prior authorization, step therapy, quantity limits)
• Pharmacy network changes
• For Medicare Advantage members, changes to medical benefits and provider networks

If you also got a document called the Evidence of Coverage (EOC), that is the long legal version. The ANOC is the short "what's different" version — start there.

The four formulary changes to look for

Part D plans update their formularies every year, and the changes tend to fall into four buckets. When you flip to the drug-coverage section of the ANOC, look specifically for these:

Tier changes. Most plans sort covered drugs into tiers, usually five or six of them, from preferred generics up through specialty. When a drug moves to a higher tier, your share of the cost usually goes up. When it moves down, it usually goes down. The ANOC will list the drugs that are switching tiers.

Prior authorization (PA). This means your doctor has to send paperwork to the plan before it will cover the drug. A medication you have taken for years can suddenly require PA in the new year — that is legal, and it is the kind of change the ANOC is designed to flag.

Step therapy. The plan wants you to try a cheaper or preferred drug first before it will cover the one your doctor prescribed. If step therapy is newly added to something you take, you will want to know before January.

Quantity limits. The plan will only cover a certain amount per fill or per month. If a limit is tightened, your usual 90-day supply might not go through the way it used to.

Drugs can also be removed from the formulary entirely, though plans generally must give notice before dropping a drug mid-year.

Your 2026-into-2027 safety net: the transition fill

If you stay in the same plan and a drug you have been taking is no longer covered — or now has a rule you cannot meet right away — Medicare requires plans to provide a one-time transition supply (typically at least a month's worth) during the first 90 days of the new plan year. That is meant to give you and your prescriber time to either request an exception, switch to a covered alternative, or change plans during the Medicare Advantage Open Enrollment Period (January 1 – March 31, for people already in a Medicare Advantage plan).

The transition fill is a bridge, not a permanent fix. Do not count on it to solve the problem — use it to buy time.

The program-level numbers worth knowing

Even before your specific plan changes are factored in, Part D itself has looked different since 2025:

• The coverage gap (the old "donut hole") is gone. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing for covered Part D drugs the rest of the year.
• The Part D maximum deductible is $615 for 2026 and $700 for 2027 (plans can set theirs lower).
• The Medicare Prescription Payment Plan lets you spread your yearly drug costs into monthly installments instead of paying big amounts at the pharmacy counter. It is optional and free to join.
• Higher-income enrollees pay an IRMAA surcharge; for a single filer in 2026, that starts above $109,000 in income.

CMS publishes the 2027 Part B premium, deductible, and IRMAA brackets later in the fall. Your ANOC will reflect the 2027 numbers for your specific plan.

A Binghamton snapshot

Binghamton is in Broome County, where — like the rest of New York — Medicare Part D and Medicare Advantage plans are sold on a county-by-county basis. That means the plan options and any formulary changes described in your ANOC are set at the county level, not the city level. Neighbors in Vestal, Endicott or Johnson City are looking at the same lineup you are.

If you want to compare your current plan to others available in Broome County, the Medicare Plan Finder at medicare.gov lets you enter the drugs you take and see how each plan on offer would handle them next year — tiers, rules and all.

A simple 30-minute review

Once the ANOC arrives, block off half an hour and do this:

1. Make a list of every prescription you currently take, with dose and quantity. 2. Open the ANOC to the drug-coverage section. For each drug, check: Is the tier the same? Any new PA, step therapy or quantity limit? 3. Flag anything that changed. 4. If something changed, call your prescriber's office to talk about alternatives, or plan to request a formulary exception. 5. If more than one thing changed, use the Plan Finder to see whether a different plan available in Broome County would cover your list more smoothly in 2027. 6. Decide by December 7 — that is when the Annual Enrollment Period ends.