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

Justin Sonon · Accepted 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.

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.

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 & ME

Answered by Tony Capraro III Medicare Insurance Agent

Charise Karjala · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/ive-been-on-a-part-d-plan-for-a-while-and-im-wondering-why-my-generic-prescriptions-suddenly-cost-more-did-something-change#charise-karjala

Brian Moore · 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.

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.

Voss Speros · Answer

Yes something did change. This year 2025, CMS put a cap on out of pocket drug costs for all beneficiaries, a $2000 annual max. 

That being said, companies added in the Drug Deductible to more tier levels, Drug ties shifted to off set costs for the Carriers. Co-payments went up, drugs got dropped from formularies 

The good thing is you won't pay over $2000 annually for covered drugs, and the carrier can spread the over all cost out over 12 months if you like.  

If you have questions Ask a Broker

Jennifer McDonnell · Answer

The Inflation Reduction Act of 2022 helped reduce the cost of some more expensive medications however as a side effect many drug plans raised the cost of generics.
Also, make sure you are using the correct pharmacy to keep drug costs down (usually savings is found using a 'preferred' pharmacy.  Your trusted insurance advisor should be able to help you find a pharmacy that best fits your plan.

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

Kathryn Zekas · Answer

Possibly. Medicare restructured the Part D (drug) plans for 2025. Many may have a deductible for certain Tiers, or possibly your Part D plan changed for this year. We would have to look at your Summary of Benefits to find out.
Also, It is a good idea to review your Annual Notice of Changes, which is mailed or emailed to you by October 3rd every year. This will show you what your current plan looks like and what it will look like for the upcoming year.

Patrick Hecht · Answer

Yes. A few things could have changed, even if you didn't switch plans. Medicare Part D plans update their formularies each year, which means the list of covered drugs and their tiers can change or shift. A generic that was in a low-cost tier last year might now be in a higher tier with a bigger copay. Also, preferred pharmacy networks can change, so if your pharmacy is no longer "preferred," your costs may go up. This is why it's important to review your plan every year during the Annual Enrollment Period to be certain you are getting the most out of your prescription plan and keeping as much in your pocket as possible.

Answered by Patrick Hecht on May 19, 2025

Broker Licensed in VA, CA, MD, PA & WV

Answered by Patrick Hecht 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

Alyssa Burgos · Answer

Medications went up this year due to the insurance companies picking up more of the cost. The government not paying as much to the insurance carriers. Make sure to reach out to a broker to look at your coverage for 2026 in October to review all your medications and pick the right plan to pay the least cost.

Answered by Alyssa Burgos on May 5, 2025

Broker Licensed in CO, AZ & TX

Answered by Alyssa Burgos 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.

Steven Bleicher · Answer

With all the publicity surrounding the volatility of prescription drugs and that every country in the world is affected by the global economy, even generic Rx's will increase its pharmacy copay at any time, not just each new calendar year. You MUST evaluate your drug plan every single year! If you initially used an agent to enroll you in a drug plan, if you are not comfortable in using the Medicare.gov website, that agent should acknowledge her/his duty to find you a competitive plan for the next year. Just because one plan was your best choice when you turned age 65 does not mean that it will remain as the best plan. It has to do with the combination of generics and brand name Rx's. You also must check the US & Canadian discount websites like GoodRx, costplusdrugs.com, simplecare.com, pharmacychecker.com and many more! Everyone has a choice: A) using your Part D plan, OR, B) using the discount sites above. You cannot use both for the same drug since that's illegal. Good luck.

Answered by Steven Bleicher on June 1, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

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.

DeeDee Whitlock · Answer

Medicare Part D as well as Part C make changes annually and I encourage you to have your agent reevaluate your plan EVERY year!!! Even if your Rx drugs have NOT changed the plan can change and Medicare can change as well!!

Answered by DeeDee Whitlock on May 27, 2025

Broker Licensed in LA

Answered by DeeDee Whitlock Medicare Insurance Agent

Cleo Martin · Answer

The plan probably changed their co-pays from last year along with doing away with the donut hole.

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.

Thomas Magnus · Answer

Yes Indeed. With passage of the IRA - Inflation Reduction Act, Medicare Beneficiaries will pay no more than $2,000 annually for their medications. Since some people cross this threshold already on January 1 and since we know there is no free lunch - we can also deduce that these costs don't simply vanish and vaporize in mid air. There are MANY changes affecting premiums, co pays, broker commissions - all in an attempt for the Rx industry to claw back some of their losses caused by this consumer friendly provision.

Answered by Thomas Magnus on June 21, 2025

Broker Licensed in CA, AZ, NV, OR & WA

Answered by Thomas Magnus Medicare Insurance Agent

Mindy Foran · Answer

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

Fred Manas · Answer

Yes, there are several reasons why your generic prescriptions might be costing more than before. These include changes in the plan's formulary, the phase of coverage you're in within your Part D plan, or the overall drug pricing. 
Here's a more detailed breakdown:
1. Formulary Changes:  Part D plans have a formulary, which is a list of covered drugs. Plans can change their formulary each year, which can affect the tiering of drugs & your out-of-pocket costs. A drug might be moved to a higher tier, which could mean a higher copay or coinsurance. Some plans have generic drugs in higher tiers, even though they are typically cheaper than brand-name drugs. 
2. Part D Coverage Phases:  Your drug costs can fluctuate throughout the year depending on which phase of Part D coverage you're in.  You're in the deductible phase until you meet your plan's deductible.  Once you reach the initial coverage phase, the plan & the beneficiary share the cost of your medications.  If you reach the donut hole (or the coverage gap), you could be responsible for a higher percentage of the drug cost. The "donut hole" is the coverage gap, but will be eliminated in 2025. 
3. Drug Pricing Changes: Drug prices can fluctuate, & manufacturers can raise prices, which can lead to higher costs for you. Shortages of medications can also affect prices, potentially causing a spike. It's also possible that the price of your specific generic drug has increased within your plan's negotiated price. 
4. Plan Changes: Plans may also change their premiums, deductibles, or coinsurance/copay percentages each year. It's important to review your plan's changes during the annual enrollment period (October 15 - December 7) & the Medicare Advantage Open Enrollment Period (January 1 - March 31). 
5. Other Potential Factors:  You may have reached your plan's out-of-pocket maximum, which could mean you're paying more for your drugs.
The Inflation Reduction Act has some changes that affect drug pricing in 2025.

Vachik Chakhbazian · Answer

Part D plans can have various factors that lead to changes in drug costs, including plan-specific formulary, manufacturer price changes, and the coverage gap or donut hole.

Andrew Kramer · Answer

Plans can change from year to year. You always need to check your Part D plan in the Annual Enrollment from Oct 15 to Dec 7, with Jan 1 as the effective date, if you make a change. That's the only time of year when you can make a change to your Part D plan, unless you move to a different state, or have some other SEP. Your agent, who signed you for your supplement, should check it for you. You can also call Medicare to do that, but during that time they are very busy. If you do it on your own, go to Medicare.gov, create an account, and check for plans.

Answered by Andrew Kramer on May 30, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Carol Thompson · Answer

Plans can change from year to year. It’s advisable or recommended to have an agent to verify this for you by letting your agent know of any medications changes.

Todd Bostic · Answer

There are some generic medications that do cost more, but not many, and with the 2025 changes, it has affected the cost of prescriptions this year.

David Christian · Answer

Great question.  Yes something very significant changed.  The carriers are now responsible for a much higher portion of the prescription costs covered in Medicare Part D.  

While the maximum amount of pocket for the Medicare client has decreased to $2000, the carriers are picking up the slack as the government decreased their financial input on prescription drug costs.  

Some carriers have countered by adding a Part D deductible.  Some carriers have swallowed a large portion of the individual prescription price increases.  Some carriers have had to implement higher copays for certain medications as their overall costs have increased.

Fran Lovelace · Answer

It's possible they changed tiers.  Part D plans should be reviewed each October with a seasoned Medicare agent.

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.

Michael Turkaly · Answer

Every year, each insurance company will come out with their formulary and Medicare Part D details of benefits. The formulary is a list of covered medications and what copay tier they will fall under. So bottom line is, the copays could change every year even if you stay on the same plan.

Answered by Michael Turkaly on April 28, 2025

Agent Licensed in MI

Answered by Michael Turkaly Medicare Insurance Agent

Steve Dunn · Answer

Medicare Part D plans can change coverage amounts annually.  Sometimes generics can be moved to higher tiers with higher co-pays.  That is why it is important to actively manage your plan.  Part D plans are not managed by the governmnt and can vary greatly between providers. 
It's ok to shop plans and seek the one tht best fits your needs.

Richard Kozlowski · Answer

Every plan is different.  You should review annually.

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?

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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?

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