Key Takeaways

• Prescription costs can change each year, and reviewing these shifts during the Annual Enrollment Period helps you avoid unexpected expenses in 2026.

• You can catch cost changes early by checking formularies, reviewing your Annual Notice of Change, and comparing plans before December 7.

Understanding Why Prescription Costs Change

Prescription costs can shift from one year to the next because plans adjust their formularies, coverage rules, and cost-sharing structures. During the Annual Enrollment Period, which runs from October 15 to December 7, 2025, you have the chance to review these updates before your 2026 coverage begins on January 1. Paying attention to the changes now helps you avoid unwanted surprises later.

Plans update their lists of covered medications, change the tier your medication falls under, or revise how much you pay in copayments or coinsurance. Because these adjustments take effect each January, keeping track of these updates is essential.

What Signals That Your Prescription Costs May Shift?

Several signs can help you identify when your medication costs might change. Knowing what to look for helps you stay prepared.

Are Your Medications Moving To A New Tier?

A medication may be assigned to a lower or higher tier than the previous year. If a drug is moved to a higher tier, your cost for that medication will likely increase. This tier movement often appears in plan updates sent to you each fall.

Is There A Change In Prior Authorization Or Step Therapy Requirements?

Plans may add new rules that require approval before certain medications are covered. If step therapy, prior authorization, or quantity limits are added or changed, this may affect how quickly you can access your medications or how much you pay.

Has The Plan Adjusted Its Pharmacy Network?

Changes to preferred or standard pharmacy networks can impact the price you pay at the counter. If your usual pharmacy is no longer listed as preferred, it may cost you more to fill your prescriptions.

Are Deductibles Or Copayments Changing?

General cost-sharing changes, including deductibles, copayments, and coinsurance amounts, can raise or lower your yearly medication expenses. Reviewing these updates helps ensure your budget stays stable.

Reviewing Your Annual Notice Of Change

Your Annual Notice of Change arrives each fall and outlines all plan updates for the coming year. It includes details on premium changes, benefits, deductible amounts, pharmacy networks, and formulary updates. Reading this notice carefully gives you a clear picture of how your prescription costs may shift for 2026.

Look for sections that list medication changes or coverage restrictions. This notice provides one of the most reliable early warnings of increased costs.

How To Catch Cost Changes Early

Staying ahead of prescription cost changes requires a step-by-step approach. By reviewing your medications before December 7, you ensure your coverage continues to meet your needs.

Why Should You Make A Current Medication List?

Start by writing down all the medications you take. Include dosage, frequency, and the form of each drug. This list helps you compare how each plan covers your prescriptions.

How Should You Check The Plan Formulary?

Every plan has a formulary, which is the list of medications it covers. Look up each of your medications and review:

• Tier placement

• Coverage restrictions

• Cost-sharing amounts

• Requirements such as prior authorization or step therapy

This helps you identify any significant changes.

Should You Compare More Than One Plan?

Comparing your current plan with at least two other options helps you see if another plan offers more favorable coverage for your medications. Even if your prescription list stays the same, the plan that worked best in 2025 may not remain the best choice in 2026.

Do Pharmacy Networks Affect Prescription Costs?

Yes. Pharmacy networks can influence how much you pay for your medications. Review which pharmacies are preferred in each plan. Using a preferred pharmacy usually lowers your out-of-pocket spending.

Understanding Deductibles And Yearly Cost Limits

General Medicare cost limits help shape your overall medication spending. For 2026, deductibles, coverage phases, and cost caps influence when and how much you pay throughout the year. Although specific private plan prices cannot be discussed, you can still understand how the structure works.

How Does The Deductible Affect You?

You may need to pay the full cost of certain medications until your plan’s deductible is met. Plans determine which tiers count toward the deductible and which do not.

When Do You Reach The Catastrophic Phase?

Once your yearly out-of-pocket spending for medications reaches a set limit, you enter the catastrophic coverage phase. After that point, you pay much less for each prescription for the rest of the year.

Common Oversights When Reviewing Prescription Costs

Some changes are easy to miss if you only glance through your plan updates. Being aware of these common oversights keeps you prepared.

1. Not Checking Tier Changes

A drug may appear on the formulary but may be placed in a higher tier with higher cost sharing.

2. Skipping Pharmacy Network Review

Many beneficiaries only look at medication coverage and overlook pharmacy network changes, which can raise costs significantly.

3. Assuming Coverage Will Stay The Same

Even if your medications have remained stable for years, plans regularly update formularies and remove drugs from preferred status.

What Should You Do If You Find A Cost Increase?

If you identify an increase in medication costs, you can take steps to manage the change before the December 7 deadline.

Is Switching Plans An Option?

Yes. AEP allows you to change your plan for coverage starting January 1, 2026. Switching may lower your medication costs if another plan covers your prescriptions more favorably.

Should You Reevaluate Your Pharmacy Choice?

Using a preferred, in-network pharmacy helps lower your medication expenses. Review pharmacy lists to make sure you are filling your prescriptions at the best location.

Can You Discuss Alternatives With Your Prescriber?

You can speak with your prescriber about possible medication alternatives that may be placed in a lower tier. Lower-tier drugs generally cost less.

Preparing For Future Cost Changes

Planning ahead helps you navigate future Annual Enrollment Periods more easily.

• Keep an updated medication list year-round.

• Save copies of plan notices and formulary updates.

• Review your plan every fall before December 7.

Tracking changes early prepares you for smooth transitions from year to year.

Staying In Control Of Your Coverage

Understanding when and why your prescription costs shift helps you feel more confident about your Medicare choices. During AEP, you have from October 15 to December 7 to make informed decisions that affect your 2026 coverage.

Moving Forward With Confidence

Making sure your prescriptions remain affordable takes careful review of formularies, pharmacy networks, and cost-sharing details. Staying alert to changes helps you keep control of your healthcare spending. If you want guidance, you may reach out to any of the licensed agents listed on this website for support.