Why Your Part D Plan Matters More Than You Think
Most people pick a Part D plan based on the monthly premium. That’s a mistake.
Two plans with the same premium can have wildly different costs for your specific medications. The difference can be $1,000+ per year depending on:
- Which formulary tier your drugs are on
- Whether your pharmacy is preferred in the plan’s network
- Whether the plan requires prior authorization or step therapy
- How costs change once you hit the coverage gap
Understanding Drug Tiers
5 Steps to Choose the Right Part D Plan
Step 1: List ALL Your Medications
Include the exact name, dosage, and quantity. Don’t forget inhalers, insulin, eye drops, and creams — they’re often the most expensive.
Step 2: Check Each Plan’s Formulary
Every Part D plan publishes a formulary — a list of covered drugs. Your medications need to be on the formulary, ideally on a lower tier.
Step 3: Verify Your Pharmacy
Plans have “preferred” pharmacies where you pay less. If your pharmacy isn’t preferred, your costs go up — sometimes significantly.
Step 4: Calculate Total Annual Cost
Add up: monthly premium × 12 + annual deductible + estimated copays for all medications. The plan with the lowest total wins — not the lowest premium.
Step 5: Check for Restrictions
Look for prior authorization requirements, step therapy (must try a cheaper drug first), and quantity limits that could affect your medications.
The $2,000 Out-of-Pocket Cap: Game Changer
Starting in 2026, no matter how expensive your medications are, you’ll never pay more than $2,000 out-of-pocket per year for Part D drugs. This new cap from the Inflation Reduction Act is a game-changer for people taking specialty medications.
Plus, the new Medicare Prescription Payment Plan lets you spread costs evenly across the year — no more $500+ bills at the pharmacy in January.
Want Us to Compare Part D Plans for Your Medications?
Send us your medication list and we’ll find the lowest-cost plan — free.
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