Medicare Part D

Same drug, new hoops in 2027? What the ANOC will tell you

BISMARCK, N.D. — The envelope usually shows up in late September, and it is easy to mistake for junk mail. But for anyone on a Part D drug plan in Burleigh County, that packet — the Annual Notice of Change, or ANOC — is the single most important piece of paper you will get before the Oct. 15 Annual Enrollment Period opens. It spells out, in black and white, how your drug coverage will look different on Jan. 1, 2027.

Drug lists are not frozen. Every year, insurers rework which medications they cover and under what rules. A pill that was easy to fill in 2026 can land on a higher tier, require prior authorization, or come with a new quantity limit in 2027. The ANOC is where those shifts appear before they hit the pharmacy counter.

What the ANOC actually is

The Annual Notice of Change is a document your Part D or Medicare Advantage drug plan is required to send each fall. It compares your 2026 coverage to your 2027 coverage, side by side. That includes the premium, the deductible, the pharmacy network, and — most importantly for many readers — the formulary, which is the plan's list of covered drugs.

If you also get an Evidence of Coverage (EOC), that is the longer rulebook. The ANOC is the short summary of what is different.

How a drug list can change

A formulary can change in several ways, and not all of them mean the drug is dropped. Common shifts include:

• Tier changes. Most plans sort drugs into tiers, roughly from generic to specialty. A drug can move up a tier (usually more expensive for you) or down a tier.
• Prior authorization. The plan requires your doctor to submit paperwork showing the drug is medically necessary before it will be covered.
• Step therapy. You must try a lower-cost drug first. If it does not work, the plan will then cover the drug you were originally prescribed.
• Quantity limits. The plan caps how much of a drug it will cover in a set time period — for example, a certain number of pills per month.
• Removed drugs. Occasionally a drug comes off the formulary entirely, though plans generally must give notice and offer alternatives.

None of these are unusual. They happen every plan year, across the industry.

How to read your ANOC without missing the important parts

You do not need to read every page. Focus on a few things:

1. Find the section labeled something like "Changes to our drug list" or "Formulary changes." 2. Look up each of your current prescriptions by name. Note any change in tier or new letters like PA (prior authorization), ST (step therapy), or QL (quantity limit). 3. Check the deductible and any changes to the pharmacy network — using an out-of-network pharmacy can change what you pay. 4. If something looks different, call the plan's member services number listed in the ANOC and ask exactly how the change affects your specific medications.

Keep the ANOC until at least the end of the Annual Enrollment Period on Dec. 7. If you decide to switch plans, you will want it as a reference.

The 2026 and 2027 program backdrop

Even as plan-level details shift, the Part D program itself has some fixed numbers worth knowing. For 2026, the out-of-pocket cap on covered drugs is $2,100, and the maximum plan deductible is $615. The old "donut hole" was eliminated in 2025, so Part D now has three phases instead of four. There is also an optional Medicare Prescription Payment Plan that lets you spread your drug costs across monthly payments instead of paying them all at the pharmacy. Higher-income enrollees — starting above $109,000 for a single filer in 2026 — pay an IRMAA surcharge on top of their Part D premium. CMS will publish the 2027 figures ahead of the plan year.

What plan choice looks like around Bismarck

Bismarck is in Burleigh County, where Medicare eligibles generally have a range of stand-alone Part D plans and Medicare Advantage plans with drug coverage to compare each fall. The exact count changes year to year as carriers enter or leave the market. The plan finder at medicare.gov lets you enter your ZIP code and your list of drugs, and it will show how each available plan would handle your specific prescriptions — including any prior authorization or step therapy flags.

Transition fills: your safety net in January

If you switch plans, or if your plan changes its formulary, and you fill a prescription in January that is not covered the same way, most plans are required to provide a one-time transition fill — typically a 30-day supply — during your first 90 days on the plan. That gives you time to work with your doctor to either switch to a covered drug or request an exception. The transition fill is not automatic forever; treat it as a grace period, not a solution.