Review your drug plan now, and potentially save thousands

Hey there,

Back when we reported our Prescription Drug Playbook series about how to avoid sticker shock at the pharmacy counter, one piece of advice came up again and again:

If you rely on specific meds, you need to do some homework when it’s time to pick next year’s insurance plan.

And that time has come, friends — whether you’re picking from different options through work, looking at Medicare Part D plans (that’s the drug-coverage letter in Medicare’s alphabet soup), or shopping for an insurance plan through the Obamacare marketplace.

Picking a better drug plan now can save you thousands of dollars in 2026 — and big headaches. And your primary care provider can be a HUGE help in choosing the right one.

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OK, now for that “saving you thousands of dollars” thing…

Don’t re-enroll without checking your plan

Your plan might work for you right now, but here’s the thing: The list of drugs that plan covers could change when the new year starts.

Jeanne Chamberlin, a volunteer coordinator for her state’s Medicare helpline, says these changes creep up on a lot of the seniors she talks with.

“People come in January… and say, I just went to the pharmacy and they want $300 for my medicine. And last year, or last month, it was $30,” Jeanne says.

Yikes. We want to make sure you avoid that scenario.

So take advantage of this moment. And give yourself some time. Crack open a soda or fix yourself a cup of tea (though maybe not Sleepytime). This could take a while.

Step 1: Hunting down the “formulary”

The formulary: That’s the master list of drugs your plan covers, and at what cost.

You want to review your current plan’s formulary for 2026 — and check it against other plans to see if you’d benefit from switching.

And because nothing in health care is allowed to be easy, those formularies live in different places, depending on where you get your insurance.

If that’s from work, “formulary” may not be in the first link HR sends you about enrollment — you might have to dig a little. (A doc called “Summary of Benefits and Coverage” might be a good place to look.)

If you’re coming up empty, or confused, call your HR Benefits manager.

If you’re shopping for an Obamacare plan, healthcare.gov, and at least some state marketplaces, allow you to enter the drugs you take in a search field to get answers about which plans cover them.

For Medicare, Plan Finder makes it even easier. (If it’s not glitching out.) When you shop for Part D plans, you start by entering a list of your drugs. The site will generate a list of plans available in your area that cover them, and at what cost. You can sort the results by “lowest drug + premium cost.”

But even with these shortcuts, you’ll still want to see the formulary to get all the details.

Step 2: Understanding the formulary

Congratulations, you found the right document. Now you just have to…decode it. Ugh.

Formularies are long, ugly documents. And even with the hydration of a good can of soda or warm cup of tea, you could still get a nasty headache reading through it. But some basics:

1. Hit Ctrl +F to search inside the document for your drugs.
2. You’ll probably see “tiers.” Tier 1 drugs are the cheapest for you. Higher tiers get more expensive from there — sometimes WAY more expensive -– all the way up to, potentially, sticker price.
3. Some drugs may be subject to other roadblocks, like a “prior authorization,” where your provider has to make a case that you need this particular med. You’ll usually see these listed in a section called “restrictions” or “notes.” All super-fun.
4. Honestly, there’s more technical garbage than we can explain here. Luckily, this guide from the Patient Advocate Foundation does a terrific job.

Again, this could take a while. Stay strong.

And it might yield bad news: Like, no plan covers all your meds at decent-sounding prices, or without onerous hoops to jump through.

In which case…

Step 3: Tapping in your provider

First, they may have alternatives for you. So ask:

• Is there an equivalent version of this medicine that would be cheaper? Like…a tablet instead of a capsule?
• What about a comparable version, like from another brand or even a generic?
• What would work for me, in combination with the other meds I’m on?

Second, if there are hoops to jump through — like those prior authorizations we mentioned — they’ll be doing a bunch of the work. Bringing them in now can give you a running start.

Also, they may know which plans make those hoops harder to jump through, or issue more denials — meaning, which plans you probably want to avoid.

More resources for open enrollment

For folks on Obamacare plans, trained navigators offer unbiased info about plans in your area.

And for folks on Medicare, resources like SHIP or the Medicare Rights Center are a must.

Finally, if you want to do a deeper dive on other options for getting your meds at an affordable price, check out our Prescription Drug Playbook. And let us know how it all goes!

And hey — one more time: If you find our reporting indispensable, please consider donating — seriously, every dollar counts. And every dollar is worth three dollars right now. Here’s that button again.

That’s all from me for now. Good luck shopping.

— Claire