June 15, 2026Finance Buzz Sarah Albertelli Most Medicare beneficiaries assume that if a prescription is covered this year, it will still be covered next year. 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 reforms from the Inflation Reduction Act. 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. 1. 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. Beginning in 2027, insurers will continue operating under the redesigned Part D benefit structure, which requires them to absorb an even larger share of certain high-cost claims. Health policy analysts have suggested that plans may respond by paying closer attention to specialty drug spending. That could result in more prior authorizations required and changes to the formulary. 2. Brand name drugs without generic competition Some medications have no generic equivalent, leaving patients without any alternatives. These prescriptions often cost substantially more than generic drugs, making them a frequent target for cost-management efforts. In some cases, a drug might remain covered but move to a higher tier. When that happens, beneficiaries must pay higher copays or coinsurance even though the medication remains available. 3. 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. Some experts believe insurers may reevaluate coverage strategies for biologics as they adapt to the redesigned Medicare benefit. Beneficiaries could see changes involving tier placements or cost-sharing structures. 4. 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. Policy groups have warned that insurers may expand the use of these programs as they adjust to the financial realities of the redesigned Part D benefits. That does not necessarily mean medications are no longer covered, but access may require additional steps that were not previously required. 5. 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 newer drugs may qualify for coverage when used to treat other approved conditions, coverage policies continue to evolve. These medications are also expensive, increasing the likelihood that plans will closely evaluate their fit within future formularies. Beneficiaries using these drugs should review their plan documents carefully during open enrollment. 6. Medications impacted by Medicare price negotiations The federal government’s Medicare drug price negotiation program is expected to expand over the next few years. While negotiated prices may reduce costs for some beneficiaries, the broader effects on formularies remain unclear. Plans still retain flexibility in how they organize coverage, assign tiers, and manage utilization. For that reason, beneficiaries taking medication selected for negotiation should avoid assuming coverage will remain unchanged from year to year.