Medicare Part D

Before your refill in January, decode the ANOC that lands this fall

In Kent, the envelope people most often ignore is the one that matters most for prescription costs. Each September, Part D and Medicare Advantage plans mail an Annual Notice of Change (ANOC) that spells out exactly how a plan's drug list and rules will look on January 1, 2027. Reading it takes about 20 minutes. Skipping it can mean a January surprise at the pharmacy counter.

What the ANOC actually is

The Annual Notice of Change is a plain-English summary your Part D or Medicare Advantage prescription drug plan is required to send before the Annual Enrollment Period begins. It compares your 2026 plan to its 2027 version, side by side. It is not marketing — it is the plan telling you, in writing, what will be different come January.

For most people in Kent, the ANOC lands in the mail (or in an online plan portal) by the end of September. If yours has not shown up by early October, call the plan's member services number on your ID card and ask for a copy. You can also view your plan's next-year formulary on Medicare's Plan Finder at medicare.gov.

How drug lists (formularies) can change year to year

Every Part D plan uses a formulary — a list of the drugs it covers, sorted into tiers. Lower tiers usually mean lower cost-sharing; higher tiers usually mean more. From one plan year to the next, a plan can:

• Move a drug to a different tier. The same medication you took all year can shift up (or down) a tier, which changes what you pay at the pharmacy.
• Drop a drug from the formulary. If a drug is removed, the plan generally has to tell you in advance and offer alternatives.
• Add a drug — often a new generic — that was not previously covered.

The rule of thumb: your medication may be identical on January 1, but the plan's treatment of it can be very different.

Utilization management: prior authorization, quantity limits, step therapy

Even when a drug stays on the list, plans can add "utilization management" rules. The ANOC will flag these. Three common ones:

• Prior authorization (PA): Your doctor has to get the plan's approval before the prescription is filled. This can add days to a refill if you're not ready for it.
• Quantity limits (QL): The plan will only cover a set amount over a set time — for example, a certain number of tablets per month.
• Step therapy (ST): You have to try a preferred (often lower-cost) drug first. Only if that one doesn't work will the plan cover the alternative your doctor originally wrote for.

None of these mean you can't get your medicine. They mean there are extra steps — and knowing about them in October is much easier than discovering them at the counter in January.

How to read your ANOC in about 20 minutes

Here is a practical way to work through it:

1. Find the "Changes to our drug list" section. Look up each of your regular prescriptions by name. 2. Check the tier. Compare the 2026 tier to the 2027 tier. A tier change means a cost change. 3. Look for the letters PA, QL, or ST next to your drugs. Those are the utilization management flags. 4. Read the deductible and out-of-pocket sections. In 2027, no Part D plan can charge a deductible higher than $700, and total out-of-pocket drug spending is capped at $2,400. The old coverage gap ("donut hole") is gone as of 2025 — there are now three phases instead of four. 5. Note the pharmacy network changes. Sometimes a preferred pharmacy becomes standard, or vice versa, which can affect what you pay.

If something on your list is changing in a way you don't like, you have from October 15 through December 7 to switch to a different Part D or Medicare Advantage plan for the following year. Medicare Advantage members also get a second window, the Medicare Advantage Open Enrollment Period, from January 1 through March 31.

Kent and King County: what "shopping around" looks like

Kent is in King County, where Medicare beneficiaries generally have a wide range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage to choose from. For 2027, King County has 49 Medicare Advantage plans from 11 carriers, compared with 68 plans from 10 carriers in 2026; 18 plans are new, 27 are not returning, 10 have been renamed, and 21 continuing plans change something in their terms (the ANOC has the specifics). Devoted Health is new to the county for 2027. CMS posts the full local list on the Medicare Plan Finder at medicare.gov each October when the next year's details go live.

Because plan availability is set at the county level, two neighbors in Kent will see the same menu of options — but the "right" plan depends on the specific drugs each person takes, the pharmacies they use, and their doctors. That's why the ANOC-plus-Plan-Finder combination is more useful than any ranking.

Transition fills: a short safety net

If you stay in the same plan and a drug you take is dropped or newly restricted on January 1, 2027, Medicare rules generally require the plan to provide a one-time transition supply (typically a 30-day fill) during the first 90 days of the new plan year. That gives you and your prescriber time to either request an exception or switch to a covered alternative. The plan will send a notice explaining what to do next.

Transition fills are a bridge, not a permanent solution. Use the time to talk to your doctor and, if needed, to file a coverage determination or appeal.

Where to get unbiased help

• medicare.gov — the official Plan Finder shows every plan available in King County and lets you enter your drug list to see how each plan would treat it in 2027.
• 1-800-MEDICARE (1-800-633-4227) — available 24/7.
• Washington SHIBA — the state's Statewide Health Insurance Benefits Advisors program is Washington's SHIP (State Health Insurance Assistance Program). Trained counselors offer free, one-on-one help, including in South King County. Call 1-800-562-6900 or visit insurance.wa.gov/shiba.