Why Your First Prescription Refill in January May Cost More

One of the most common January surprises with Medicare involves prescription drug costs — especially that first refill of the year.

Here’s why it happens.

Most Medicare Part D plans have an annual deductible. The maximum deductible for 2026 is set by CMS at $615. If your plan includes one, it resets January 1. Until that deductible is met, you may pay more out of pocket for medications — even if you paid very little in December. The deductible may only apply to some tiers of meds depending on your specific coverage.

Once the deductible is satisfied, your costs usually settle back into the familiar copays or coinsurance you expect. This is a normal part of how Part D works and does not mean your plan is wrong or that something went wrong with enrollment.

Other January factors can also affect costs:

• Tier placement may have changed(can request tier exception)

• Pharmacy pricing can vary

• A drug may now require prior authorization

The most important thing to remember: a higher January cost is usually temporary.

If your January prescription cost catches you off guard, take a breath and ask questions. Consider if the Medicare Prescription Payment Plan may be a good fit. Anyone can sign up by calling your Part D company and asking. This spreads your costs throughout the year.
Medicare drug coverage has a rhythm to it — and once you’re past the early part of the year, things often smooth out quickly.

You don’t have to navigate it alone. Scan the QR code in our ad to seek our assistance.

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We do not offer every plan available in your area. Currently we represent 10 organizations which offer 106 products in your area.Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program(SHIP) to get information on all of your options.