Stay Ahead of Medicare Drug Coverage Changes
When it comes to Medicare Part D or prescription drug coverage through a Medicare Advantage plan, many people assume that once they enroll, they’re set for life. But that’s not the case.
Every year, insurance companies make important changes to prescription drug plans—changes that could affect your out-of-pocket costs, the drugs covered, and even which pharmacies you can use. If you’re not paying attention, you could end up with a plan that no longer meets your needs.
At Ed McMahan Medicare Insurance in Prescott, AZ, we help local residents understand and stay on top of these annual changes so they can avoid surprise costs and make smart decisions during Medicare Open Enrollment.
📍 3623 Crossings Dr, Ste 277, Prescott, AZ 86305
📞 (928) 379-0172
📧 edmcmahan2020@gmail.com
Why Prescription Drug Plans Change Every Year
Medicare Part D plans are administered by private insurance companies, not the federal government. Each year, these companies adjust their plans based on
- Changes in drug pricing
- Updates to Medicare regulations
- Shifts in provider or pharmacy contracts
- Business decisions to remain competitive
This means your plan could look very different from year to year—even if it has the same name.
6 Key Ways Your Drug Coverage Can Change Each Year
Changes in the Drug Formulary (Covered Medications)
Your plan’s formulary is the list of medications it covers. Every year, plans review and revise this list.
- A drug may be removed completely
- It might be moved to a more expensive tier
- Prior authorization may be newly required
Drugs are categorized in tiers (Tier 1 = generics, Tier 5 = specialty). Plans often shift medications from one tier to another, which directly affects your copays or coinsurance.
If you don’t check the new formulary, you might find that a medication you rely on is no longer covered.
Changes to Tier Structur
- A drug in Tier 2 may move to Tier 3, doubling your cost
- Some drugs may now require step therapy before approval
- These small changes can lead to big increases in your monthly expenses.
Pharmacy Network Changes
Part D and Advantage plans often have a preferred pharmacy network that offers lower drug prices. Plans update these networks each year.
You may find that your preferred pharmacy:
- It is no longer “preferred,” resulting in higher copays
- Is dropped from the network altogether
- This could lead to higher costs or more travel time for prescriptions.
Premium, Deductible, and Copay Adjustments
Even if your plan keeps the same name, your financial responsibility can increase in several w
- Higher monthly premiums
- Higher annual deductibles
- Increased copays or coinsurance
Coverage Rules and Restrictions
Plans may introduce new utilization management rules like
- Prior authorization: You’ll need plan approval before getting certain medications.
- Step therapy: You must try cheaper drugs first before “stepping up” to the prescribed one.
- Quantity limits: Restrictions on how much medication you can get at once.
- These changes can cause treatment delays and frustration if not reviewed ahead of time.
Availability of Better Plans
Even if your plan doesn’t change much, better plans may become available each year. You won’t know unless you compare.
- Lower costs
- Better pharmacy access
- Improved drug coverage
- More customer support
At Ed McMahan Medicare Insurance, we check every available plan in Prescott and the surrounding areas to find your best match—not just one that’s “good enough.”
📍 Why You Need a Local Medicare Expert
Sorting through dozens of changing drug plans can feel overwhelming. And online tools often miss the nuances of your local network or needs.
That’s why Prescott residents trust Ed McMahan Medicare Insurance for:
- Personalized, no-cost reviews
- Drug-by-drug plan comparison
- Local pharmacy insights
- Trusted Medicare advice with zero sales pressure
Contact Ed McMahan Medicare Insurance. Don’t wait until your medications cost more or are no longer covered.
📍 3623 Crossings Dr, Ste 277, Prescott, AZ 86305
📞 (928) 379-0172
📧 edmcmahan2020@gmail.com
5 Frequently Asked Questions (FAQs)
When do prescription drug plans update each year?
Changes are published in October, during Medicare Open Enrollment (Oct 15–Dec 7). That’s the time to review and switch if needed.
Will I be notified if my plan changes?
Yes, your plan will send an “Annual Notice of Change” by September 30 each year. But many people don’t read it—or understand it fully.
What if my medication isn’t covered next year?
You can switch to a new plan during open enrollment. Ed can help you compare options and choose one that still covers your meds.