Part D Plans Are Not All the Same
Every standalone Medicare Part D plan and every Medicare Advantage plan with drug coverage has its own formulary — the specific list of covered drugs, organized into cost tiers. Two plans can have wildly different costs for the exact same medication depending on which tier it lands on, which is why “cheapest premium” and “cheapest overall” are often two different plans.
Step 1: Get Your Exact Medication List
Before comparing anything, write down every medication you currently take, including dosage and frequency. Even small differences — a generic versus brand-name version, or a slightly different dosage — can affect which tier a drug falls into on a given formulary.
Step 2: Check Each Plan’s Formulary for Your Specific Drugs
Search each plan’s formulary for every medication on your list, not just the ones you take most often. A plan that covers 9 of your 10 medications well but excludes or heavily restricts the 10th may end up costing more overall than a plan that covers all 10 at a more modest cost.
Step 3: Watch for Utilization Management Restrictions
Some drugs on a formulary come with extra requirements: prior authorization (your doctor must get approval before the plan covers it), step therapy (you must try a cheaper alternative first), or quantity limits. These restrictions can add delays or extra steps even when a drug is technically “covered.”
Step 4: Confirm Your Pharmacy Is Preferred, Not Just In-Network
Many Part D plans have a preferred pharmacy network with meaningfully lower copays than their broader in-network pharmacies. Using a preferred pharmacy, when available near you, can make a real difference in your annual costs.
Step 5: Understand the 2026 Cost Structure
The 2026 Part D deductible is up to $615, and total out-of-pocket drug spending is capped at $2,100 for the year — after that, covered drugs cost $0 for the rest of the calendar year. Knowing where the deductible and cap sit helps you compare plans on realistic annual cost, not just the sticker price of the premium.
Review Every Year, Not Just Once
Formularies and costs change annually. A plan that was the best fit last year may not be this year, which is exactly what the Annual Enrollment Period (AEP) is for.
Have questions? Schedule a free review with Kayla Price, a licensed insurance agent at Price Services Group. Call 866-648-1578 or visit priceservicesgroup.com/schedule.
Price Services Group, LLC is not affiliated with or endorsed by the U.S. government or the federal Medicare program. NPN: 18530055 | Agency NPN: 20387435