Key Takeaways

• Your Annual Notice of Change (ANOC) provides the clearest picture of how your prescription drug coverage will look in 2026, helping you decide whether staying with your current plan still fits your needs.

• You can evaluate drug coverage changes more easily by focusing on a few essential areas instead of trying to understand every technical detail.

Understanding The Purpose Of Drug Coverage Reviews During AEP

The Annual Enrollment Period, running from October 15 to December 7 each year, gives you a chance to review your Medicare options for the upcoming year. Since drug coverage often changes from one year to the next, this period is your opportunity to check whether your prescription needs will still be met in 2026. Even if your medications have stayed the same, your plan’s rules, pricing, or coverage structure may shift. This is why reviewing drug benefits is one of the most important steps during AEP.

Rather than reading all technical documents word for word, you can focus on specific sections that show how your prescription access and costs may change. By breaking the process into manageable parts, you can make informed decisions without feeling overwhelmed.

Why Drug Coverage Changes Every Year

Drug coverage adjustments happen for several reasons. Plans update their formularies based on new clinical guidelines, contract changes, medication costs, and shifts in availability. These updates affect your level of coverage in the new year. Some changes can work in your favor, while others may increase your out-of-pocket spending.

The main updates you will notice during AEP include:

• Medications moving to different tiers.

• Medications being added or removed from the formulary.

• New prior authorization or step therapy requirements.

• Changes to deductibles, cost sharing, or annual limits.

By understanding why these changes occur, you can better anticipate what to look for as you prepare for 2026 coverage.

How Should You Begin Reviewing Drug Coverage Changes?

Start with your Annual Notice of Change (ANOC) letter. This document outlines what will change in your plan for the following year. With drug coverage, the ANOC will help you identify key areas to focus on without needing to study the entire plan brochure.

Steps to begin:

• Gather your current medication list.

• Compare each medication against the 2026 formulary.

• Look for changes in tier placements.

• Check whether any new coverage rules are being added.

Taking a few minutes to organize this information helps simplify the rest of your review.

What Part Of The Formulary Should You Look At First?

You should begin with the tier structure. Tiers determine how much you will pay for your prescriptions. Each tier includes different types of medications, and changes in tier placement can significantly affect your costs.

Key areas:

• Medications moving to higher tiers may lead to higher cost sharing.

• Medications moving to lower tiers may reduce your overall spending.

• A drug leaving the formulary requires special attention since it may no longer be accessible.

Understanding the tier structure allows you to identify early whether your plan will still work efficiently for your current prescription needs.

How Much Do Tier Changes Influence Out-Of-Pocket Costs?

Tier changes can have one of the largest impacts on what you pay throughout the year. Even if your medication is still covered, shifting from a preferred tier to a non-preferred tier may increase the amount you pay at the pharmacy.

When reviewing tier changes:

• Look for increases in copay or coinsurance amounts.

• Check whether your medication has moved into a specialty tier.

• Evaluate how many of your medications fall into each tier for the new year.

This helps you estimate your expected costs for 2026 without reviewing complex cost tables in full.

What Should You Know About Prior Authorization And Step Therapy?

Coverage rules such as prior authorization, step therapy, and quantity limits can affect how easily you receive your medication. These rules may change from one year to the next.

You should check for:

• New prior authorizations that may slow access.

• Added step therapy requirements that may require trying different medications first.

• Updated quantity limits that may change how often you refill your prescriptions.

These requirements are important because they can create delays or require additional communication with your doctor.

Why Should You Check The Annual Deductible And Cost-Sharing Structure?

General costs, such as deductibles and cost sharing, have a direct influence on your overall budget for the year. While you are not reviewing private plan prices, you can still review how your potential out-of-pocket exposure may shift for 2026.

Focus on:

• Any changes to the annual deductible.

• Shifts in cost-sharing percentages for higher tiers.

• Adjustments to the threshold that moves you into different drug coverage phases.

These updates help you understand whether your coverage will remain predictable throughout the year.

Why Should You Review Preferred Pharmacy Networks?

Pharmacy networks may change each year, affecting where you can fill your prescriptions at the lowest cost. Your plan may remove pharmacies you currently use or add new ones.

Areas to check:

• Whether your current pharmacy remains part of the network in 2026.

• Whether mail-order options remain available.

• Whether using a preferred pharmacy can help lower your costs.

This step helps prevent surprises when you visit the pharmacy in January.

How Can You Evaluate Changes Without Getting Lost In Technical Terms?

Since drug coverage information includes many technical terms, it helps to break the process into smaller parts and use your ANOC as your guide. You can also use comparison tools, speak with licensed professionals, and rely on clear summaries rather than dense documents.

Ways to simplify the process:

• Review only the sections that apply to your own medications.

• Take notes as you compare formularies.

• Use your medication list to identify specific concerns.

• Reach out for assistance if you are unsure about any change.

These steps help you stay focused on what matters most for your personal situation.

How Should You Estimate Your Likely Drug Spending For 2026?

A general estimate helps you understand whether your plan will still be affordable. This does not require exact calculations but instead focuses on identifying patterns.

Look at:

• Whether any of your medications have moved to a higher tier.

• Whether new authorization requirements could delay access.

• How the deductible structure compares with previous years.

By gathering these details, you can build a reasonable expectation of how your spending may change.

What Should You Do If You Notice Unfavorable Changes?

If your review shows that your costs may increase or access may become more difficult, you can explore other Medicare options during AEP. This is why reviewing drug coverage early in the enrollment window is helpful. You have until December 7 to make a decision that will take effect January 1.

Before switching, take time to compare new options, check their formularies, and evaluate pharmacy networks. Ensuring that your medications are covered as you expect will help you make a confident choice.

Preparing For A Smoother Medicare Year

Reviewing drug coverage changes does not have to be overwhelming. By concentrating on the sections that directly affect your prescriptions, you can understand your options clearly and make informed decisions. If you need help reviewing your choices or want guidance on how these changes may affect you, consider speaking with any of the licensed agents listed on this website. They can provide support in reviewing your options and understanding the next steps.