Medicare Part D

Your Part D Drug Could Move Tiers Jan. 1 — Here's Why

SALT LAKE CITY — October 2025. If you take a regular prescription and you're on a Medicare Part D plan, something important is landing in your mailbox this month: the Annual Notice of Change, or ANOC. It's the packet that tells you how your drug plan will work starting January 1, 2026 — and for many Salt Lake City residents, at least one detail about a covered medication will look different next year.

The ANOC is easy to set aside. It shouldn't be. Even when a drug stays on your plan's list, the rules around it — the tier it sits on, whether it needs prior approval, how much you can fill at once — can change from one year to the next. Reading the ANOC before December 7 gives you time to act during the Annual Enrollment Period if something no longer fits.

What actually changes on a drug list

Every Part D plan — whether stand-alone or built into a Medicare Advantage plan — publishes a formulary, the list of drugs it covers. Plans can update that formulary each year, and the changes usually fall into four buckets:

Tier changes. Most formularies group drugs into tiers, roughly from lowest-cost generics up to specialty drugs. A drug that was on a lower tier this year could move to a higher one next year, or vice versa. The drug is still covered — but the cost-sharing category has shifted.

Prior authorization. This means your plan wants your doctor to submit paperwork explaining why you need the drug before it will pay. It's often applied to expensive medications or drugs with safety concerns.

Quantity limits. The plan caps how much of a drug you can get in a set period — for example, a maximum number of tablets per month.

Step therapy. The plan asks you to try a lower-cost alternative first. If that doesn't work, you can "step up" to the drug you and your doctor originally wanted.

None of these tools are new, and they're not unique to any one plan. They're standard utilization management practices allowed under Medicare Part D rules.

How to read your ANOC without losing an afternoon

The Annual Notice of Change is written to compare this year to next year, side by side. A few pages deserve your attention:

• The formulary changes section. Look for your specific medications by name. Note any tier change, and check the columns for prior authorization (PA), quantity limits (QL), or step therapy (ST).
• Premium, deductible, and cost-sharing tables. These show what you'll pay next year for each tier.
• Pharmacy network updates. A pharmacy that was "preferred" this year might be "standard" next year, which can affect your out-of-pocket cost.

If your drug picked up a new restriction or moved to a higher tier, that's your cue to compare plans on medicare.gov's Plan Finder during the October 15 – December 7 Annual Enrollment Period. You enter your drugs, and the tool shows how each plan available in Salt Lake County would handle them.

What's new for 2026

Some Part D changes for next year apply across every plan, everywhere:

• The annual out-of-pocket cap is $2,100. Once you hit that in covered drug costs, you pay nothing more for covered Part D drugs the rest of the calendar year.
• The maximum Part D deductible is $615. Plans can set their deductible lower, but not higher.
• The coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan is available to anyone on Part D. It lets you spread your yearly drug costs into monthly payments to the plan instead of paying the pharmacy at pickup. It doesn't lower total cost — it smooths it.
• IRMAA — the income-related surcharge on Part B and Part D premiums — begins above $109,000 in income for a single filer in 2026.

If your drug is affected mid-year

Plans can make certain changes during the plan year, too, though CMS restricts what and when. If your drug is removed or restricted mid-year, plans generally must give you notice and, in many cases, offer a transition fill — usually a one-time supply — so you and your prescriber can either request an exception, switch to a covered alternative, or appeal.

You have the right to request a formulary exception if your doctor believes the covered alternatives won't work for you. Your plan must respond within set timeframes, and you can appeal a denial.

Where to go for personal answers

This article explains the mechanics. For questions about your own drugs, your own plan, or your own income situation, use the sources built for that:

• Medicare.gov — Plan Finder, formulary lookup, and official Part D rules.
• 1-800-MEDICARE (1-800-633-4227), available 24/7.
• Utah's SHIP — the Senior Health Insurance Information Program, part of the Utah Department of Insurance, offers free one-on-one counseling to Salt Lake City residents and other Utahns.