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?
Answered by 31 licensed agents
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.
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!
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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!!
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.
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.
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.
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.
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.
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.