Medicare Part D

Your 2027 drug list may shift: how to read the ANOC

Orem, Utah — Later this month, if you have a Medicare Part D plan or a Medicare Advantage plan that includes drug coverage, a thick envelope will land in your mailbox. It's called the Annual Notice of Change, or ANOC, and it spells out exactly what will be different about your plan on January 1, 2027. For anyone taking a regular prescription, this is the single most important piece of mail you'll get all fall.

The ANOC arrives by late September each year, ahead of the Annual Enrollment Period that runs October 15 through December 7. Skimming past it is a common — and sometimes costly — mistake, because the drug list ("formulary") and the rules attached to each drug can look very different from one plan year to the next.

What the ANOC actually is

The Annual Notice of Change is a plain-English (usually) summary from your current plan comparing your 2026 coverage to your 2027 coverage. It covers premiums, the deductible, the pharmacy network, and — the part that trips people up most — the formulary and its rules.

Read alongside the ANOC, you'll also get an Evidence of Coverage (EOC), which is the long-form contract. If you only have time for one, read the ANOC first. Flag anything that mentions your drugs, your pharmacy, or the words "tier," "prior authorization," "step therapy," or "quantity limit."

How drug lists change year to year

Every Part D plan groups covered drugs into tiers — typically five or six of them, running from preferred generics on the low end to specialty drugs on the high end. Your cost-share depends on which tier a drug sits in.

Plans are allowed to redesign that tier structure each year. A drug that was on a lower tier in 2026 can move to a higher tier in 2027, or vice versa. A drug can also be dropped from the formulary entirely, or a new one added. Generic equivalents that came to market during the year often shift the landscape.

Plans must give notice before making most negative mid-year changes, but the bigger reshuffles happen at the January 1 turnover — which is exactly what the ANOC previews.

Utilization management: the rules behind the drug

Beyond tiers, plans use three main tools — collectively called utilization management — to control how a drug is dispensed:

• Prior authorization (PA): Your prescriber has to get the plan's approval before the drug is covered. If a drug you already take gets PA added for 2027, your pharmacy may turn you away at the counter in January until paperwork is filed.
• Step therapy: The plan requires you to try a lower-cost option first and show it didn't work before it will cover the drug your doctor originally prescribed.
• Quantity limits: The plan will only cover a set amount over a set time — for example, a certain number of pills per month.

None of these are new or unusual. But each one is worth checking against your current prescriptions in the ANOC, because a rule that wasn't there in 2026 can quietly appear for 2027.

Transition fills give you breathing room

If you stay in your plan and a drug you already take gets dropped or hit with a new restriction, federal rules require your plan to offer a transition fill — generally a one-month supply within the first 90 days of the new plan year. That gives you and your prescriber time to either request an exception, switch drugs, or, if you're still in the AEP window, choose a different plan.

Transition fills are a safety net, not a permanent fix. Use the time.

Comparing plans in Orem

Orem is in Utah County, where Medicare beneficiaries typically have a wide range of stand-alone Part D and Medicare Advantage prescription drug plans to compare each fall. The plan finder at medicare.gov lets you enter your specific prescriptions, doses, and preferred pharmacy, then shows how each plan would treat them next year — including tier placement and any utilization management rules.

That comparison is the honest apples-to-apples check the ANOC can't give you by itself, because the ANOC only tells you about the plan you're already in.

A few 2026 numbers worth knowing

While the ANOC concerns your 2027 coverage, the current program rules for 2026 shape the backdrop:

• The Part D out-of-pocket cap is $2,100 in 2026 — once you hit it, you pay $0 for covered drugs for the rest of the year.
• The maximum Part D deductible is $615 in 2026 ($700 in 2027).
• The old "donut hole" coverage gap was eliminated in 2025; there are now three payment phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across monthly payments instead of paying large amounts at the pharmacy counter.
• IRMAA surcharges for higher-income beneficiaries begin above $109,000 in income for a single filer in 2026.

Watch your 2027 ANOC for updated versions of these figures.