How to Check If Your Medications Are Covered Next Year

Every fall, health plans update their drug lists for the coming year. A medication you fill without a second thought today can move to a pricier tier, pick up a new approval requirement, or drop off the list entirely, and most people find out at the pharmacy counter in January. Open enrollment is your window to check if your medications are covered next year, while you can still do something about it.

The quick answer

Before you renew or pick a plan for 2027, look up every medication by name on that plan’s 2027 drug list (called a formulary). For each one, note three things: whether it’s listed, what tier it’s on, and whether it has any extra rules attached. If a drug isn’t listed, you have options, including asking the plan for an exception. But the easiest fix is catching the problem now, while you can still change plans.

This works the same way whether your coverage comes through work, the Health Insurance Marketplace, or Medicare. Only the deadlines and the tools are different.

Know your deadline first

Type of coverage	Open enrollment for 2027
Medicare (Part D drug plans and Medicare Advantage)	October 15 to December 7, 2026. Changes start January 1.
HealthCare.gov Marketplace plans	November 1, 2026 to January 15, 2027. Pick a plan by December 15 for coverage that starts January 1.
State-run Marketplaces	Dates can differ. Check your state’s site.
Employer plans	Set by your employer, often a short window in the fall. Check with HR or your benefits portal.

If you have Medicare, your plan sends an Annual Notice of Change (ANOC) in September. It lists what’s changing for next year, including drug coverage. If you or your parent didn’t get one, call the plan and ask for it.

A few terms you’ll see on every drug list

• Formulary (drug list): the list of prescription drugs a plan covers.
• Tiers: groups of drugs sorted by cost. Lower tiers (usually generics) cost you less. Higher tiers (brand-name and specialty drugs) cost more.
• Prior authorization (PA): the plan has to approve the drug before it will pay. Usually your prescriber sends in information showing why you need it.
• Step therapy (ST): the plan wants you to try a lower-cost drug first before it covers the one you were prescribed.
• Quantity limits (QL): the plan covers only a certain amount over a set time, such as 30 tablets a month.

How to check if your medications are covered, step by step

1. Make a complete list. Write down every prescription by exact name, strength, and how often it’s taken. Include inhalers, eye drops, injections, and anything filled only a few times a year. If you’re helping a parent, her pharmacy can usually print a medication history, which is the easiest place to start.
2. Find the right year’s drug list. Make sure you’re looking at the 2027 formulary, not this year’s. For Medicare, the Plan Finder on Medicare.gov lets you enter your drugs and see how each plan covers them. For Marketplace and employer plans, go to the insurer’s website (look for “drug list,” “formulary,” or “find a drug”) or your benefits portal. If you can’t find it, call the member services number on the insurance card.
3. Search each drug by name. Search both the brand name and the generic name. Some lists show only one, and a drug can look “missing” when it’s really listed under the other name.
4. Check the tier. Compare next year’s tier with this year’s. A move from a generic tier to a higher tier can mean a bigger copay or coinsurance.
5. Look for the letters. Codes like PA, ST, or QL next to a drug mean extra rules apply. Each plan’s drug list has a key that explains its codes.
6. Check the pharmacy. What you pay often depends on using an in-network pharmacy. Confirm that the pharmacy you use (and mail order, if you use it) is in the plan’s network for 2027.
7. Write it down. Make a simple chart: drug, covered yes or no, tier, any rules, estimated cost. If you’re comparing two or three plans, this chart is how you’ll spot the difference fast.

What to do if a drug isn’t listed

First, don’t stop taking anything on your own. You have several paths, and the right one depends on timing.

If it’s still open enrollment

The simplest option may be choosing a plan that does cover the drug. Run the same check on the other plans available to you before the deadline.

Ask your prescriber about a covered alternative

Plans often cover a different drug in the same class. Only your prescriber can decide whether a switch makes sense for you. Bring a printout or screenshot of the plan’s covered options to the appointment so the conversation goes quickly.

Request an exception

An exception is when a plan agrees to cover a drug that isn’t on its list, or to waive a rule like step therapy or a quantity limit. You or your prescriber can ask, and your prescriber will need to explain the medical reason, such as covered drugs not working or causing harmful side effects.

• Medicare drug plans: once the plan has your prescriber’s supporting statement, it generally must decide within 72 hours, or within 24 hours if you ask for a fast decision because waiting could seriously harm your health.
• Marketplace and employer plans: each insurer has its own exceptions process. Call the plan and ask how to start one and how long a decision takes.

If an exception is denied, you can appeal. Marketplace plan members can also ask for an independent external review.

Know about transition fills

If you’re new to a Medicare drug plan and a drug you already take isn’t covered, or needs prior authorization or step therapy, you may be able to get a one-time, 30-day transition supply when your coverage begins. It buys time; it doesn’t solve the problem. Use those weeks to work with your prescriber on an exception or a covered alternative. Some Marketplace insurers also offer a one-time refill after you first enroll, so it’s worth asking.

As a pharmacist, I would much rather you find a coverage gap in November than at the pharmacy counter in January. A careful check now is far easier than an urgent one later.

Your screenshot checklist

• Do I have the 2027 drug list, not this year’s?
• Is every medication listed, by brand or generic name?
• What tier is each drug on, and did any tier change?
• Do any drugs need prior authorization or step therapy, or have quantity limits?
• Is my usual pharmacy in network next year?
• Would mail order or a 90-day supply cost less on this plan?
• What’s my deadline to switch plans?
• If a drug isn’t covered, what’s the plan’s exception process, and who do I call?

Questions to ask the plan by phone:

• “Is [drug name and strength] on your 2027 formulary, and on what tier?”
• “Are there any prior authorization, step therapy, or quantity limit rules for it?”
• “If I have an approval for this drug now, does it carry over to next year?”
• “How do I request an exception, and how long does a decision take?”

Common mistakes to avoid

• Assuming nothing changed. Drug lists can change from one year to the next, even if you keep the same plan.
• Checking this year’s list. Make sure the formulary says 2027.
• Looking only at “covered or not.” A drug can be covered but sit on a higher tier or require prior authorization, which affects both your cost and how quickly you can get it.
• Leaving out “occasional” drugs. A rescue inhaler or a seasonal prescription still counts.
• Waiting until January. Once open enrollment ends, your chances to switch plans are much more limited.
• Changing a medication on your own. If cost or coverage is a problem, talk to the prescriber first. Never stop, skip, or split doses to stretch a prescription.

When to talk to your pharmacist, doctor, or plan

• Your pharmacist can help you build an accurate medication list, sort out brand and generic names, and tell you what a drug costs under your current plan.
• Your prescriber is the person to talk to about covered alternatives and to send in exception or prior authorization requests. Ask early, because paperwork takes time.
• Your plan can confirm next year’s coverage, tiers, and network pharmacies, and walk you through exceptions and appeals.
• For Medicare questions, your State Health Insurance Assistance Program (SHIP) offers free, unbiased one-on-one counseling.

An hour this fall, one drug list at a time, can save you or your parent a surprise bill and a scramble in January.

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This article is for educational purposes only and is not medical, legal, or insurance advice. Talk with your pharmacist, doctor, or health plan before changing your medications or coverage. Some links may be affiliate links; see our disclosure.