If you have a Medicare Part D prescription drug plan or a Medicare Advantage plan with prescription drug coverage, one of the most important things you can do each year is check your plan’s formulary.
Many people assume that if their medications haven’t changed, their drug coverage won’t either. Unfortunately, that’s not always the case.
Drug plans update their formularies every year, and those changes can have a significant impact on your out-of-pocket costs.
What Is a Medicare Formulary?
A formulary is the official list of prescription medications that a Medicare drug plan covers. Every Part D and Medicare Advantage prescription drug plan has its own formulary.
A formulary doesn’t simply list covered drugs—it also includes:
- Which medications are covered
- The pricing tier for each drug
- Whether prior authorization is required
- Whether step therapy applies
- Any quantity limits on prescriptions
- Preferred pharmacy requirements
Even if you’re taking the exact same medications as last year, your plan’s formulary may have changed.
Why Formularies Change Every Year
Insurance companies review and update their formularies annually. Changes can happen because:
- New medications become available.
- Generic versions replace brand-name drugs.
- Drug prices change.
- Medicare regulations change.
- Contracts with pharmaceutical manufacturers change.
These updates typically take effect on January 1 each year.
How Formulary Changes Can Affect You
A medication that cost you $10 per month this year could cost $75—or may no longer be covered at all—next year.
Common changes include:
- Your medication moves to a higher cost tier.
- Your medication requires prior authorization.
- Your pharmacy is no longer preferred.
- A different medication becomes the preferred option.
- Your medication is removed from the formulary.
If you don’t review these changes during Medicare’s Annual Enrollment Period, you may not discover them until you go to refill your prescription.
When Should You Review Your Drug Coverage?
The best time is during Medicare’s Annual Enrollment Period (October 15 through December 7).
During this time, compare your current drug plan with other available plans for the upcoming year.
Even if you’re happy with your current coverage, taking just a few minutes to compare plans could save hundreds—or even thousands—of dollars.
Tips for Checking Your Formulary
Before comparing plans, make a complete list of:
- Every prescription medication you take
- The dosage of each medication
- How often you take it
- Your preferred pharmacy
Then verify:
- Is every medication covered?
- Has the cost tier changed?
- Are there new restrictions?
- Is your pharmacy still in-network?
- Would another Medicare plan lower your total costs?
Don’t Assume Your Plan Is Still the Best Choice
Many Medicare beneficiaries stay in the same plan year after year because it’s easier than shopping around.
But plans change.
Premiums change.
Deductibles change.
Drug costs change.
A plan that was the best choice last year may no longer be the best fit for your health needs or your budget.
Get Expert Help Reviewing Your Options
Comparing Medicare drug plans can be confusing, especially when formularies, deductibles, pharmacy networks, and coverage rules all vary from one plan to another.
At YourMedicareMN, we help Minnesota Medicare beneficiaries review their prescription drug coverage, compare available plans, and understand how formulary changes may affect their healthcare costs.
Our goal is simple: help you make informed Medicare decisions with confidence.
Frequently Asked Questions
Do Medicare formularies change every year?
Yes. Medicare Part D and Medicare Advantage drug plans typically update their formularies annually. Covered medications, pricing tiers, and coverage rules can all change.
What if my medication is no longer covered?
You may be able to switch to a covered alternative, request a formulary exception, or enroll in another Medicare drug plan during an eligible enrollment period.
Should I compare plans if my prescriptions haven’t changed?
Absolutely. Even if your medications stay the same, your plan’s formulary, costs, and pharmacy network may have changed.
Need Help Choosing the Right Medicare Drug Plan?
Choosing a Medicare prescription drug plan doesn’t have to be confusing.
At YourMedicareMN, we help Minnesota Medicare beneficiaries compare their options, understand their coverage, and make informed decisions based on their unique prescription needs.
Visit Contact Us to schedule a personalized Medicare review and get answers tailored to your situation.
For official Medicare information, visit the Medicare.gov website.