6 Prescription Drugs Medicare Part D Could Stop Covering in 2027 - Check Your Plan Now

Most Medicare beneficiaries assume that if a prescription is covered this year, it will still be covered next year. However, that isn't always the case. Medicare Part D plans update their formularies annually, and 2027 may bring more changes than usual as insurers continue adjusting to major Inflation Reduction Act reforms.

Some retirees may see lower out-of-pocket costs under the redesigned benefit. Others could encounter narrower formularies, higher tiers, or new coverage restrictions for certain medications. For people whose retirement savings are stretched thin, even a small change in prescription coverage can impact their budget. 

Here are some types of drugs that may face greater scrutiny in 2027.

Specialty medications

Specialty drugs are among the most expensive medications covered by Medicare Part D. They are commonly prescribed for conditions like multiple sclerosis, rheumatoid arthritis, cancer, and other serious illnesses.

The redesigned Part D benefit changes how plans and beneficiaries share prescription drug costs. The annual out-of-pocket maximum for covered Part D drugs rises from $2,100 in 2026 to $2,400 in 2027.

Plans could respond to these financial pressures by paying closer attention to specialty drug spending. That could mean changes to formularies, drug tiers, or utilization management requirements such as prior authorization.

Brand-name drugs without generic competition

Some medications have no generic equivalent, leaving patients without an equivalent lower-cost option.

These prescriptions can cost substantially more than generic drugs, making them a focus of cost-management efforts. A drug might remain covered but move to a higher tier, which could mean higher copays or coinsurance for beneficiaries.

That's why it's important to check where each prescription appears on your plan's 2027 formulary rather than assuming coverage will stay the same.

Biologic medications

Biologic drugs are produced from living organisms and are commonly used to treat autoimmune diseases, certain cancers, and inflammatory conditions.

Because these medications are often expensive, they tend to represent a sizable portion of prescription drug spending. Plans may review how they cover biologics, including their formulary placement and cost-sharing requirements.

If you're taking a biologic, review your 2027 plan materials for changes to its tier, coverage rules, or preferred alternatives.

Drugs that have lower-cost alternatives

Medicare drug plans frequently encourage the use of lower-cost medications when multiple treatment options are available. One tool plans use is step therapy. 

Under step therapy rules, a patient may be required to try a less expensive drug before coverage is approved for a more costly option.

That doesn't necessarily mean a medication is no longer covered. Instead, getting coverage could require additional steps that weren't previously required.

Weight-loss medications

Weight-loss drugs remain one of the most closely watched categories in prescription drug coverage.

Medicare has historically restricted coverage for medications prescribed solely for weight loss, although some drugs may qualify for coverage when used to treat other approved conditions. Coverage policies can vary by plan and indication, so beneficiaries should check their 2027 plan documents carefully.

There's another important development for people taking certain diabetes and obesity medications. Negotiated Medicare prices for 15 additional Part D drugs take effect Jan. 1, 2027. The group includes popular GLP-1 medications Ozempic and Wegovy.

Those negotiated prices could reduce costs for some Medicare beneficiaries, but they don't mean every plan will cover every medication in the same way. Check your plan's 2027 formulary and cost-sharing information before assuming your coverage or out-of-pocket costs will change.

Medications impacted by Medicare price negotiations

Medicare's drug price negotiation program is expanding, with negotiated prices for a second group of 15 Part D drugs taking effect Jan. 1, 2027.

The group includes drugs used to treat diabetes, asthma, chronic obstructive pulmonary disease, prostate and breast cancer, and other conditions. Ozempic and Wegovy are among the medications included.

Negotiated prices are intended to reduce what Medicare pays for selected high-cost drugs, and they could also reduce costs for some beneficiaries. But beneficiaries shouldn't assume that a negotiated drug will automatically have the same coverage or cost-sharing terms in every Part D plan.

Plans still determine their formularies, tiers, and utilization-management requirements within Medicare's rules. Check your 2027 plan materials to see how your medication will be covered.

Why some retirees could face narrower formularies in 2027

The redesigned Part D benefit creates different outcomes depending on a beneficiary's prescription needs.

People with extremely high drug costs have stronger protection against catastrophic spending, but plans may also look for ways to manage prescription spending through formulary placement and utilization-management tools.

The Part D out-of-pocket maximum is $2,400 in 2027, up from $2,100 in 2026. Once beneficiaries reach the annual limit on covered Part D out-of-pocket spending, they pay $0 for covered Part D drugs for the rest of the year.

That makes reviewing your plan especially important if you take several expensive medications or expect high prescription costs in 2027.

What to do during open enrollment

The Medicare open enrollment period runs from October 15 to December 7 each year. During this window, beneficiaries should compare plans rather than automatically renewing their current coverage. Your plan's Annual Notice of Change is sent each fall and includes changes to coverage and costs that take effect in January.

A drug that was affordable this year may move to a different tier next year. A medication that did not require prior approval may suddenly require additional paperwork.

Before choosing a plan for 2027:

• Review a plan's updated formulary
• Search every prescription you take using Medicare's Plan Finder
• Check for new prior authorization requirements
• Look for step therapy restrictions
• Compare total annual drug costs, not just monthly premiums
• Contact your insurer if a medication appears to have changed status
• Reach out to your local SHIP counselor for free Medicare guidance

Bottom line

Medicare Part D coverage is never set in stone. Even if your prescriptions are covered today, formulary updates, tier changes, and new utilization rules could impact what you pay in 2027. Taking a few minutes to review your plan during open enrollment may help you avoid unexpected costs and make the right moves before the new coverage year begins.

Medicare plans must notify members when covered drugs are removed or moved to a different tier. Reading these annual notices instead of automatically renewing coverage can help you spot potential problems before you arrive at the pharmacy counter.

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