What you need to know about Medicare Part D in 2026
Prepare for your 2026 plan year
Each year, Medicare Part D plans, including Medicare Advantage plans, make updates to their prescription drug benefits. It’s important to review your 2026 coverage so you’re prepared for your first prescription fills in the new year. To get ready for the 2026 plan year, be sure to:
- Confirm your prescriptions are still on the covered drug list (formulary)
- Find out if your drugs have a deductible
- Review your copay and coinsurance amounts
- Find out if your drug needs prior authorization or other requirements
Find the right pharmacy for you
After you’ve checked your coverage, you’re ready to fill your prescriptions. Here’s what to know.
Access thousands of pharmacies nationwide
Your plan helps make getting prescriptions easier with thousands of network pharmacies to choose from, including home delivery and retail pharmacies. Choose the convenience of prescriptions delivered right to your doorstep with Optum Home Delivery Pharmacy or fill your prescriptions through your favorite local retail or independent pharmacy.
How can I save on prescription drugs?
When it comes to saving on medications, here are a few tips to help you get the most for your money — and use your benefits to the fullest.
What are prior authorization and coverage requirements?
Some prescription drugs may have limits or require extra steps before they can be filled using your plan coverage.
How do I know if my medication requires prior authorization?
On the drug list, medications that require prior authorization or have coverage requirements may have a code by them. Here are examples of the codes you may see:
- PA: Prior authorization — You or your health care provider need prior approval for a drug, to make sure it is being used correctly for your health condition
- ST: Step therapy — You may be required to use another effective, lower-cost medication for your condition first
- QL: Quantity limit — The plan may limit the amount of a drug you can fill at one time to make sure that it is used safely and effectively
What should I do if my medication requires prior authorization?
If your drug has one of these requirements or limits, your provider will need to provide more information in order for the plan to cover the drug. Your provider may also choose to change your prescription to another medication. Your plan may cover a one-time fill as a transition. This gives you time to work with your doctor or pharmacy to get the help you need. If this happens, contact your doctor or pharmacy.
Want to see if your drug has an authorization or coverage requirement? Sign in to the member site and look up your drug.
Frequently asked questions about prescription drug coverage
A drug list or formulary is a list of medications that shows how they’re covered by your plan. If you have a prescription for a certain kind of medication, you can look it up in your plan formulary to see how it’s covered. Plans may add or remove specific prescription drugs from their drug lists from year to year.
Yes, there is a $0 copay for most Part D covered adult vaccines, including the shingles vaccine.1
If you’re keeping an eye on your health care costs, it might be a good idea to talk to your provider about switching from a brand name to a generic drug that treats the same condition. Generics have the same active ingredients found in brand-name versions — and are just as safe and effective.2 This could save you hundreds of dollars per year.3
You can fill prescriptions at any network pharmacy. If you’re traveling and away from your home pharmacy, sign in to your member site to find the closest pharmacy and contact the pharmacy to fill your prescription.
If you have a stand-alone Part D plan, another option is an all-in-one Medicare Advantage prescription drug plan.4 Medicare Advantage plans often:
- Offer the same drug coverage, but with lower premiums and copays
- Combine your doctor, hospital and prescription drug coverage, all in one
- May include extras like vision, dental and hearing benefits