Medicare Part D

Before You Refill in January, Read the ANOC That Just Landed

In High Point, the mail that hits mailboxes each September carries more weight than it looks. The Annual Notice of Change, or ANOC, is your Part D or Medicare Advantage plan's plain-language warning that something about your drug coverage is shifting on January 1, 2027 — and the window to do anything about it runs from October 15 to December 7, 2026.

High Point is in Guilford County, where dozens of Medicare drug and Advantage plans are offered, and every one of them can adjust its formulary — the list of covered drugs — from one plan year to the next. The pill you filled without a hiccup all year may sit on a different tier, need paperwork, or come with a new quantity cap starting in January. Knowing how to read the ANOC is how you catch that before the pharmacy counter does.

What the ANOC actually is

The Annual Notice of Change is a document your current plan is required to send you each fall. It compares your 2026 coverage to your 2027 coverage, side by side. If your premium, deductible, pharmacy network, or drug list is changing, the ANOC is where it shows up first — usually in a table near the front.

It is not junk mail, and it is not a sales pitch. Think of it as your plan telling you, in writing, exactly what will be different when you fill a prescription in January.

The four ways a drug list can change

Part D formularies are living documents. Plans review them each year and update them within rules set by CMS. Four kinds of changes matter most:

Tier changes. Most plans sort covered drugs into tiers, roughly from lowest cost-share (generics) to highest (specialty). A drug that was on a lower tier this year can move to a higher tier next year, which usually means you pay more at the counter.

Prior authorization. The plan may start requiring your doctor to submit paperwork showing the drug is medically necessary before it will be covered. Same drug, new hoop.

Quantity limits. The plan may cap how much of a drug it will cover in a given period — for example, a set number of pills per month.

Step therapy. The plan may require you to try a lower-cost alternative first. If that drug does not work or is not tolerated, the plan will then cover the one you originally wanted.

None of these mean a drug is gone from coverage. They mean the path to getting it has changed.

How to read the ANOC in ten minutes

Start with the summary table showing 2026 versus 2027. Then jump to the drug coverage section and look for any mention of your specific prescriptions. Check three things:

1. Is each drug still on the formulary? 2. What tier is it on now, and what tier will it be on in January? 3. Are there new letters next to it — often PA (prior authorization), QL (quantity limit), or ST (step therapy)?

If anything looks different, that is your cue to call your plan, talk to your prescriber, or compare other plans during open enrollment.

What 2027 looks like program-wide

A few Part D rules apply to every plan, no matter which one you're in:

• The out-of-pocket cap is $2,100 for 2026. Once your spending on covered drugs hits that, you pay $0 for covered drugs the rest of the year.
• The maximum deductible any plan can charge is $615.
• The old "donut hole" coverage gap has been eliminated 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 installments instead of paying large 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.

Transition fills: your safety net

If you switch plans, or your plan drops a drug you've been taking, federal rules generally require the new or continuing plan to give you a one-time transition supply — typically a 30-day fill — early in 2027. That gives you and your doctor time to either request an exception, switch to a covered alternative, or appeal.

Do not assume the transition fill will just keep happening. Use that month to sort out a longer-term answer.

Your High Point action list

• Watch for your ANOC in late September and set it aside somewhere you'll actually read it.
• Make a current list of every prescription you take, with dosage.
• Between October 15 and December 7, use the Plan Finder at medicare.gov to compare how each plan covers your specific drugs.
• If you're already in a Medicare Advantage plan, you get a second window — the Medicare Advantage Open Enrollment Period, January 1 through March 31 — to make one change.
• Free, unbiased help is available from North Carolina's SHIIP (the state's SHIP program), which serves Guilford County residents at no cost.