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Can I switch Part D plans if my drug is dropped?

Usually not. A drug coming off your plan's list mid year does not let you switch plans. You get notice, often keep it through December, and can ask for an exception.

Updated September 3, 2026 · 3 min read · by Gerino Alejos

Usually not. A drug coming off your plan's formulary, the list of drugs it covers, does not by itself let you change plans mid year. You do have other protections, and it helps to know them before it happens.

What plans can and cannot do mid year

Plans generally cannot remove a drug, or move it to a higher price tier, during the plan year without a reason. There are exceptions.

• A generic version comes out, and the plan swaps it in
• The FDA pulls the drug for safety, which takes effect right away
• The maker takes the drug off the market

In most other cases the plan must tell you ahead of time. If you are already taking the drug, you are usually allowed to keep getting it through the end of the plan year.

Your protections: notice and transition fills

• Advance notice, generally at least 30 days, or a 30 day supply at the old terms
• Continued coverage for the rest of the year in many cases, if you were already taking the drug
• The right to ask for a formulary exception, a request to cover the drug anyway, with your doctor's support
• The right to appeal a denial through several levels

Start with the exception request. Do not assume you have to change plans or pay cash. Exceptions for a drug you are already stable on succeed more often than people expect, especially when your doctor shows that other drugs have been tried.

When you can change plans

You need a qualifying event, a life change that Medicare accepts as a reason to switch outside the normal windows. A formulary change is not one. These events do qualify.

• Moving out of the plan's service area, the counties where the plan is sold
• The plan leaving your area or losing its Medicare contract
• Gaining, losing or changing Medicaid or Extra Help, the program that lowers drug costs for people with limited income
• Moving into or out of a skilled nursing facility, a place that gives nursing care after a hospital stay
• A five star plan being offered in your area, which allows one switch during the year

That last one is useful, and few people know about it. If a Part D or Advantage plan with Medicare's top five star rating is sold where you live, you may switch to it once during the year, outside the normal windows.

What to do right now

1. Ask the plan in writing why the drug is no longer covered and whether continued coverage applies to you.
2. Have your doctor file a formulary exception. Ask for an expedited request if going without would harm you.
3. If the plan says no, appeal. Ask the plan for the appeal steps in writing.
4. Ask your doctor whether a covered alternative would truly work for you.
5. Check whether a five star plan is offered in your area.
6. If none of that solves it, plan to change during Annual Enrollment in the fall, and price plans on that one drug.

How to avoid it next year

The Annual Notice of Change (ANOC) arrives in September. It lists the formulary changes for the coming year. Reading it is how you catch a tier change or a dropped drug before January, instead of at the pharmacy counter in February.

See how to read your ANOC and how to check a formulary. If you would like help with the exception request or with the fall comparison, call our McAllen office or send us your ZIP code through the form on this page.

Gerino Alejos

Licensed insurance agent · License 3128710 · NPN 18243381

Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.