Your Part D Plan From Last Year Might Already Be Out Of Date

Key Takeaways

• Even if your Medicare Part D plan served you well last year, 2025 may bring changes in drug formularies, premiums, and pharmacy networks that impact your costs.

• Reviewing your plan annually is essential—especially in light of new 2025 rules like the $2,000 out-of-pocket prescription drug cap.

Why Annual Review Matters More Than Ever in 2025

Every year, Medicare Part D plans are updated. Formularies shift, pharmacies join or exit networks, and premiums may rise or fall. For 2025, these changes are even more significant. New federal rules have reshaped how plans operate, including cost-sharing requirements and drug coverage phases. If you haven’t reviewed your plan since last year’s Open Enrollment, you might be surprised by how much has changed.

Here’s what’s happening this year:

• Medicare Part D now includes a $2,000 annual cap on out-of-pocket costs for prescription drugs.

• The coverage gap phase, once known as the “donut hole,” has effectively been eliminated.

• Some plans have adjusted their formularies to control costs under the new cap.

• Drug tiers may have been reorganized, changing how much you pay for common medications.

The $2,000 Out-of-Pocket Cap Is a Game Changer

One of the most significant changes for 2025 is the introduction of an out-of-pocket maximum for Part D coverage. After you spend $2,000 on covered prescription drugs, your plan must cover 100% of additional costs for the rest of the year. This cap provides financial protection, especially for those with high drug costs.

But this change also creates ripple effects:

• Plans may tighten formularies, limiting brand-name drug access.

• Preferred pharmacy lists may shift to control spending.

• Copayment structures could evolve to steer you toward generics or mail-order options.

Even if you’re not a high-volume prescription user, it’s still smart to see how your current plan has reacted to this shift.

Formularies Shift—And That Affects You

A plan’s formulary—the list of drugs it covers—is rarely static. Most plans revise their lists each year, adding some drugs and removing others. In 2025, many are adjusting more aggressively due to cost controls under the new cap.

What this means for you:

• A drug you took in 2024 may now be excluded or moved to a higher-cost tier.

• Prior authorization may now be required for drugs that didn’t have restrictions before.

• New generics may be covered, while brand-name alternatives are dropped.

You can find this information in your plan’s Annual Notice of Change (ANOC), which is mailed each fall. If you didn’t check it then, it’s still not too late to reevaluate your options now and switch plans during a future enrollment period.

Network Changes May Limit Your Pharmacy Choices

Medicare Part D plans use pharmacy networks, and those networks can shift yearly. For 2025, many plans have changed preferred or in-network pharmacies to manage new cost structures.

Ask yourself:

• Is your usual pharmacy still in-network?

• Are you now required to use mail-order services to avoid higher costs?

• Has your plan introduced a narrower network with fewer local options?

If your pharmacy is now considered out-of-network or non-preferred, your out-of-pocket costs may be significantly higher than last year—even for the same drugs.

Premiums and Deductibles Don’t Stay the Same

Every year, premiums and deductibles fluctuate based on federal benchmarks and plan-level decisions. For 2025:

• The average Part D premium has decreased slightly, but individual plans may still increase your share.

• The maximum deductible has increased to $590.

• Some plans now offer lower initial copays to encourage early-year adherence but raise them later in the coverage phase.

Just because your premium appears affordable doesn’t mean the plan remains a good fit. Higher copays or restrictions might cancel out any savings.

Drug Tier Reclassifications May Raise Your Costs

Drug tiers determine what you pay for each prescription. Most Part D plans have multiple tiers:

• Tier 1: Preferred generics

• Tier 2: Non-preferred generics

• Tier 3: Preferred brand drugs

• Tier 4: Non-preferred brands

• Tier 5: Specialty drugs

In 2025, many plans have reassigned medications to different tiers in response to the new $2,000 cap. Your generic may now cost more, or a brand-name drug may require higher cost-sharing than it did in 2024.

Review your plan’s drug list to see if any of your medications moved between tiers, which can directly affect how much you pay at the pharmacy counter.

Plan Benefit Structures Are Changing

Some plans have introduced new benefit structures to comply with 2025 guidelines while trying to remain competitive. You might encounter:

• Lower monthly premiums paired with higher tier copays.

• Enhanced benefits for mail-order refills but reduced retail pharmacy support.

• Incentives to use in-network pharmacies only.

These adjustments may shift how and where you get your prescriptions—even if you stayed with the same plan.

Extra Help and LIS in 2025: Still Available, Still Underused

If you qualify for the Extra Help (Low-Income Subsidy or LIS) program, your drug costs can be substantially reduced. In 2025, this program continues to provide:

• Lower or no premiums (based on the benchmark plan in your area)

• Reduced or no deductibles

• Lower copays for brand-name and generic medications

However, plan changes can still affect which benchmark plans qualify, so even LIS recipients should review their coverage annually.

Annual Notice of Change: What You Should’ve Looked For

Each fall, your plan sends you an Annual Notice of Change (ANOC). This document outlines:

• Premium and deductible changes

• Drug formulary updates

• Pharmacy network adjustments

• Prior authorization or step therapy changes

If you didn’t read it last year, it’s worth pulling it out now. The ANOC is your roadmap to understanding what may have changed between 2024 and 2025.

What You Can Do If You Missed Open Enrollment

The Annual Enrollment Period (October 15 – December 7) is the main opportunity to switch Part D plans. But if you missed it, you may still qualify for a Special Enrollment Period (SEP) if you:

• Moved to a new address

• Lost creditable drug coverage

• Entered or left a nursing home

• Gained eligibility for Extra Help

Even without a qualifying event, mark your calendar for the next Open Enrollment window. In the meantime, review your costs and coverage.

It’s Not Too Late to Compare for the Rest of the Year

While plan changes have already taken effect in 2025, it’s still wise to analyze your costs:

• Check whether your current pharmacy is still in-network

• Review your latest Explanation of Benefits (EOB) to see what you’re paying

• Contact your plan to clarify tier levels and coverage rules

If the costs are higher than expected, preparing early for the next enrollment period ensures you don’t repeat the same mistake.

Smart Planning Starts Now

Even if you feel your plan is working, don’t assume it still offers the best value. With Part D’s evolving landscape, your needs and your plan’s offerings may not match as well as they did in 2024.

Start building your comparison list today:

• Visit the Medicare Plan Finder tool

• Make a list of your current medications

• Compare pharmacy networks

• Track your current out-of-pocket spending

Proactive review can mean the difference between manageable costs and unwelcome surprises.

Reviewing Your Part D Plan in 2025 Is a Must

You owe it to yourself to stay ahead of the changes. Medicare Part D is not a set-it-and-forget-it program. The landscape evolves every year—and 2025 is no exception. Whether it’s the new out-of-pocket cap, shifting pharmacy networks, or changing formularies, the time to act is now.

If you’re unsure about your current plan, get help from a licensed agent listed on this website to explore whether your plan still aligns with your medication needs and budget.