Medicare Part D

2027 Part D changes: Des Moines, WA

# Your Part D drug got a green light in 2026. Will it in 2027?

DES MOINES, Wash. — The envelopes are landing in mailboxes across King County this month, and a lot of them will get tossed on the "deal with it later" pile. That's the mistake worth avoiding. The Annual Notice of Change, or ANOC, is the document that tells you whether the prescription you filled without a hiccup all year is going to look the same on January 1 — or whether it's about to move to a different tier, need your doctor's signature on a prior authorization form, or be capped at a smaller monthly quantity.

Part D drug lists — the formularies — are rebuilt every year. Plans can move drugs between cost tiers, add utilization management rules, or swap one medication for a preferred alternative. None of that is unusual. What's unusual is when a Des Moines reader finds out about it at the pharmacy counter in January, instead of during the Annual Enrollment Period that runs October 15 through December 7.

What a formulary actually is

A formulary is the list of prescription drugs a Part D plan agrees to cover. Every plan builds its own, following rules set by the Centers for Medicare & Medicaid Services (CMS). Drugs are sorted into tiers — usually five or six — and the tier a drug lands in affects what you pay at the pharmacy. Generics typically sit on lower tiers. Brand-name and specialty drugs sit higher.

Here's the part people miss: a drug can be covered in both 2026 and 2027 and still cost you more, because the plan moved it up a tier. Same pill, same pharmacy, new price.

The three utilization management tools

Beyond tiers, plans use three tools to control how and when a drug is dispensed. All three are allowed under CMS Part D rules, and any of them can appear on your medication for the first time in a new plan year.

Prior authorization (PA). Before the plan pays, your doctor has to send paperwork explaining why you need this specific drug. This is common for expensive medications or drugs with safety concerns.

Step therapy. The plan asks you to try a lower-cost drug first. Only if that one doesn't work — or you can't tolerate it — will the plan cover the drug your doctor originally prescribed.

Quantity limits. The plan caps how much of a drug you can get in a set period, usually a month. If your prescription is for more than the limit, the pharmacy can't fill the full amount without an override.

None of these mean the drug is off the formulary. They mean there's a gate in front of it.

How to read the ANOC without falling asleep

The ANOC is not short. But you don't need to read every page — you need to find a few specific things.

1. The premium and deductible for 2027. These are on the first few pages. 2. The formulary change section. Look for a table or list showing drugs that are moving tiers, being removed, or having new restrictions added. 3. Your drugs, by name. Cross-check every prescription you take against that list. If a drug isn't mentioned, it's generally staying put — but confirm by looking at the full formulary on the plan's website or by calling. 4. The pharmacy network. Preferred pharmacies can change too, and that affects your cost even when the drug itself doesn't move.

If something on your list is changing, you have until December 7 to switch to a different Part D or Medicare Advantage plan for the following year. After that, the Medicare Advantage Open Enrollment Period (January 1 – March 31) gives Advantage enrollees one more window to change, but the rules are narrower.

What's actually new in 2027

A few program-level facts apply to every Part D plan in 2027, no matter which one you're in:

• The out-of-pocket cap for covered drugs is $2,400 in 2027, up from $2,100 in 2026. Once you hit it, you pay nothing for covered Part D drugs the rest of the year.
• The maximum deductible a plan can charge is $700 in 2027, up from $615 in 2026.
• There are three coverage phases — deductible, initial coverage, and catastrophic. The old "donut hole" was eliminated in 2025.
• The Medicare Prescription Payment Plan is still available. It lets you spread your drug costs across the calendar year in monthly bills instead of paying big amounts at the pharmacy.
• Higher-income enrollees pay an IRMAA surcharge on Part D premiums, starting above $109,000 in income for a single filer in 2026.

Des Moines is in King County, where 49 Medicare Advantage plans from 11 carriers are offered for 2027 — down from 68 plans and 10 carriers in 2026, with 18 new plans, 27 not returning, and 10 renamed. Devoted Health is new to the county. If your current plan's 2027 formulary doesn't work for you, there are other options to compare on medicare.gov.

If January catches you off guard

Sometimes the ANOC gets buried, and you find out at the counter. Two things to know.

First, ask about a transition fill. New CMS rules require Part D plans to provide at least a one-time, temporary supply of a drug you were already taking, so you have time to work things out. This applies whether you're new to the plan or your current plan changed its formulary.

Second, you and your prescriber can request a formulary exception or file an appeal. If your doctor believes the covered alternative won't work for you medically, that's the basis for asking the plan to cover your original drug — or to waive a step therapy or quantity limit.

Where to get personalized help

Medicare rules are national, but your prescriptions and your budget are yours alone. For a personalized look:

• medicare.gov — the Plan Finder lets you enter your drugs and see how each 2027 plan handles them.
• 1-800-MEDICARE (1-800-633-4227) — available 24/7.
• Washington SHIBA, the state's SHIP program — free, unbiased counseling from trained volunteers, with no plan to sell.