If you’re enrolled in a Medicare Part D prescription drug plan—or a Medicare Advantage plan that includes prescription drug coverage—one of the most important things you can do each year is review your plan’s drug formulary.
Many people assume that because their medications were covered this year, they’ll automatically be covered the same way next year. Unfortunately, that’s not always the case.
A few minutes spent reviewing your plan during Medicare’s Annual Enrollment Period could save you hundreds—or even thousands—of dollars.
What Is a Medicare Drug Formulary?
A formulary is simply a list of prescription medications that your Medicare drug plan covers.
Each plan creates its own formulary, which includes:
- The medications it covers
- Which tier each medication belongs to
- Your expected copayment or coinsurance
- Any coverage restrictions, such as prior authorization or step therapy
Because every plan is different, two Medicare Part D plans may cover the same medication very differently.
Why Formularies Change Every Year
Insurance companies review and update their formularies annually.
Changes may include:
- A medication moving to a different pricing tier
- New prior authorization requirements
- Step therapy requirements
- Quantity limits
- Preferred pharmacy changes
- Medications added or removed from the formulary
These changes can affect both your costs and how easily you obtain your prescriptions.
What Happens If You Don’t Check?
Failing to review your formulary could result in:
- Higher prescription costs
- Unexpected pharmacy bills
- Delays while obtaining prior authorization
- Having to switch medications
- Discovering your pharmacy is no longer preferred
Most of these surprises can be avoided by reviewing your coverage before the new plan year begins.
When Should You Review Your Drug Coverage?
The best time is during Medicare’s Annual Enrollment Period (October 15 through December 7).
This is when you can compare available Medicare prescription drug plans and Medicare Advantage plans for the upcoming year.
Even if you’re happy with your current coverage, it’s worth taking a few minutes to confirm that:
- Your medications are still covered.
- Your preferred pharmacy remains in-network or preferred.
- Your costs haven’t changed significantly.
- Another plan may better fit your needs.
What Information Should You Have Ready?
Before comparing plans, make a current list of:
- All prescription medications
- Dosages
- How often you take each medication
- Your preferred pharmacy
Having this information makes it much easier to compare your options accurately.
Don’t Focus Only on the Premium
Many people choose a Medicare drug plan based solely on the monthly premium.
However, a plan with a slightly higher premium may save you much more if:
- Your medications are placed in lower-cost tiers
- Your preferred pharmacy offers lower pricing
- Your prescriptions are covered with fewer restrictions
The total annual cost—not just the monthly premium—is what matters most.
We’re Here to Help
Choosing a Medicare prescription drug plan can be confusing, especially when formularies change each year.
At YourMedicareMN, we help Minnesotans compare Medicare prescription drug coverage so they can make informed decisions based on their medications, pharmacies, and healthcare needs.
Our goal is simple:
Learn First. Choose With Confidence.
If you’d like help reviewing your Medicare drug coverage, we’re happy to provide a complimentary consultation.
📞 952-201-5991
🌐 YourMedicareMN.com
Frequently Asked Questions
Do Medicare Part D formularies change every year?
Yes. Medicare drug plans typically update their formularies annually. Medications, pricing tiers, and coverage rules may change from year to year.
Can my medication be removed from my plan?
Yes. A medication may be removed from a formulary or moved to a different tier. Your plan will generally notify you of significant changes, but reviewing your coverage each year is still important.
Should I compare plans every year?
Yes. Even if you’re satisfied with your current Medicare drug plan, comparing available options during the Annual Enrollment Period may help you reduce your overall prescription costs.
Can YourMedicareMN help me compare drug plans?
Yes. We help Minnesotans understand their Medicare options and compare prescription drug coverage based on their individual medications and healthcare needs.
YourMedicareMN can help you understand your options.
Whether you’re turning 65, already on Medicare, or reviewing your prescription coverage for next year, YourMedicareMN can help you understand your options. 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.