I've been on a Part D plan for a while, and I'm wondering why my generic prescriptions suddenly cost more. Did something change?

Question

Brian Moore · Accepted Answer

Your generic prescription costs might be rising because Part D plans update their formularies, premiums, and copays each year, and I’ve seen many people overlook the need to review these changes annually. In my view, it’s a frequent mistake—failing to reassess coverage as costs and policies can shift significantly, especially this past year with the Biden-Harris Inflation Reduction Act taking effect. The Act introduced a $2,000 out-of-pocket cap for 2025, but it also altered how plans and manufacturers share costs, which can increase generic prices depending on your specific plan’s structure.

Answered by Brian Moore on March 26, 2025

Broker Licensed in OH

Answered by Brian Moore Medicare Insurance Agent

Melonie Wood · Answer

On Prescription Plans Part D, all depends on the Part D plan, formulary/ what Tiers the medications fall in.

Tony Capraro III · Answer

There were many changes in 2025 to the Part D prescription drug plans. They change annually so you want to make sure you're checking to see that your Prescriptions are covered. PS Lots of my clients use Good RX and have been pleasantly surprised with the low cost for generics using it!

Answered by Tony Capraro III on March 27, 2025

Agent Licensed in NH

Answered by Tony Capraro III Medicare Insurance Agent

Joseph Bachmeier · Answer

As a broker I review my clients drug plans on an annual basis. I do so because the drug plans change such as your monthly premium, the deductible and the copays. Sometimes the formularies change. You get an annual letter in October which is usually titled "Notice of Change" explaining any changes to your plan for the forthcoming year. 
As a broker I email all my clients once in September and once in October reminding them about the upcoming Annual Enrollment Period, and to reach out to me with their updated scripts so I can review their coverage and suggest any changes they may need to make.

Lt Col Tim Brown · Answer

I would need to know what medications you’re on. That way I can work on that answer by looking at the different formularies from different companies.

Justin Sonon · Answer

Plan formularies can change from year to year, as well as plan deductibles and copays, so it's always best to check your prescription options annually or as your prescriptions change.

Alondra Arce · Answer

There are a few reasons why that could be happening. Sometimes plans update their formularies at the start of the year, which can change how certain drugs are covered, even generics. It’s also possible that your medication moved to a different tier, or that the pharmacy you’re using is no longer a preferred one with your plan, which can raise the cost.

Answered by Alondra Arce on April 15, 2025

Agent Licensed in CA, AL, AR & 14 other states

Answered by Alondra Arce Medicare Insurance Agent

Joshua Cooper · Answer

In 2024 the inflation reduction act had a major impact on the Medicare space specifically Part D and drug plans. It is important to review your drug plan each year to make sure you are up to date on any relevant changes. This usually can be done within 5-15 minutes for each of our clients.

Answered by Joshua Cooper on March 27, 2025

Broker Licensed in GA, AL, FL & 10 other states

Answered by Joshua Cooper Medicare Insurance Agent

Corey Romero · Answer

If your same prescriptions from the same pharmacy on the same drug plan suddenly cost more this year, you’re not crazy. Part D plans reset every January, and even if you didn’t switch plans during Annual Enrollment Period (October 15 - December 7), your plan may have changed on you!

The drug list, or formulary, may have shifted, bumping your med to a higher tier with a higher copay or dropping it from coverage altogether. They send those notices out in easy to overlook mailings and e-mail notifications that are generally ignored by many people who are happy with their coverage. That is, until those changes take effect.

And we can’t forget about the pharmacy game. If your go-to mom and pop shop isn’t considered a “preferred” pharmacy anymore, you’ll end up paying more just for sticking with what’s familiar. The big boys are playing hard ball and sometimes our local pharmacies end up paying the price or are forced to pass that on to you.

Bottom line: plans change, prices go up, and most people don’t find out until they’re standing at the pharmacy counter in January. 

Don't wait to review these changes after you receive the shocking bill. Stay on top of changes or work with someone who will help review your options as part of your client relationship.

Gregg Matheny · Answer

Yes, unfortunately carriers can occasionally alter the tier of a medication from “generic” (tier1) to “preferred generic” (tier2). In some cases a generic medication may even jump up to a tier 3! I have noticed that these changes usually happen when the plan starts anew on 1/1. Most carriers have an online RX lookup tool for members, you may try looking up your medications every so often.

Answered by Gregg Matheny on March 26, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Leslie Helene Sussman · Answer

Each year the Medicare formulary and Prescription plans on covered Medications could change and be a different copay than the previous year.   If you have a Medicare Broker have them check for you.

Valentina Gatewood · Answer

Lets check which medication you are on with the plan tiers, and compare it to last year so we can see what has changed. We can then calculate your out of pocket cost for 2025 for all the medications.

Mindy Foran · Answer

More information would be needed in order to respond to this question properly.  More information would be required.

Steven Rodriguez Giudicelli · Answer

There's a few things to consider: Generic drug costs might be higher because:
 * Your plan changed its preferred drug list.
 * Different pharmacies charge different amounts.
 * The price of the generic drug itself went up.
 * You've moved to a different phase of your plan's coverage.
 * Insurance rules are shifting slightly.
What to do:
 * Check your plan's drug list.
 * Call your insurance company.
 * Compare pharmacy prices.
 * Ask your doctor about other options.