If you’re enrolled in Medicare Part D, staying updated with changes to your prescription drug coverage is crucial. As of April 2025, there have been significant formulary updates, including new drugs and opportunities to switch your Medicare plan—even if it’s outside of the regular enrollment period.

Let’s dive into what’s new and how you can ensure you have the best coverage for your medications.

Medicare Part D 2025: Major Drug List Updates

Over the past month, Medicare Part D plans have added 52 new prescription drugs, represented by 95 new National Drug Codes (NDCs). This means some medications come in multiple forms or strengths.

Notable New Brand-Name Drugs Added:

• BAQSIMI 3 MG Spray – Covered by 16 stand-alone drug plans and 161 Medicare Advantage plans.
• DANZITEN 71 MG Tablet – Covered by 37 stand-alone drug plans and 302 Medicare Advantage plans.
• IMKELDI 80 MG/mL Solution – Covered widely, appearing on 40 drug plans and 340 Medicare Advantage plans.
• REVUFORJ 110 MG Tablet and RUBRACA 200 MG Tablet – Each is included in coverage across over 340 Medicare Advantage plans.

Important New Generic Drugs for 2025:

• CELECOXIB 50 MG (Generic for Celebrex) – Covered by nearly all major plans (39 PDPs, 344 MAPDs).
• GLIPIZIDE ER 10 MG (Generic for Glucotrol XL) – Widespread coverage (40 PDPs, 345 MAPDs).
• NAPROXEN DR 375 MG (Generic for EC-Naprosyn) – Available in 36 PDPs and 320 MAPDs.

These additions mean you may now have broader coverage for medications previously not included or covered at higher costs.

Can I Change My Medicare Part D Plan Now?

Yes, there are special circumstances called Special Enrollment Periods (SEPs) allowing you to change your Medicare Part D or Medicare Advantage plan even after regular enrollment periods end.

Common Scenarios Allowing You to Change Plans:

• 5-Star Medicare Advantage Plan: If there’s a top-rated (5-star) plan available in your area, Medicare allows a once-a-year change to these highly rated plans.
• Dual Eligibility (Medicare and Medicaid): You can switch plans once a month between January and November.
• Relocation: If you move out of your plan’s service area, you automatically qualify for an SEP to select a new plan.
• Long-term Care: Entering or leaving a long-term care facility qualifies you for an immediate SEP.
• VA or TRICARE Coverage: Those receiving VA or TRICARE benefits may disenroll from Medicare Part D without penalty.
• Significant Network Changes: If your current Medicare Advantage plan significantly changes its healthcare provider network, you might qualify for an SEP.

What if My Current Plan Dropped My Medication?

Unfortunately, there’s no automatic SEP for drugs replaced by generics. Plans can replace a brand-name drug with a generic mid-year, and this doesn’t automatically allow you to switch plans.

Will My Deductibles Transfer if I Change Plans?

• Prescription Drug Deductible: Yes, your deductible spending transfers if you switch Medicare Part D plans mid-year.
• Medicare Advantage Out-of-Pocket Spending: This transfer is more limited and case-specific.

Need Expert Help or Have Questions?

Navigating Medicare Part D changes and SEPs can be complicated. Rather than navigating this process alone or relying solely on government resources, you can directly reach out for personalized assistance.

At PlanMedicare.com, we specialize in simplifying Medicare decisions. Instead of calling SHIP or Medicare.gov, get clear, personalized guidance from an experienced advisor.

Contact us today:

• 🌐 Visit PlanMedicare.com
  
• 📞 Call us at 516-900-7877

We’ll make sure you have the best possible coverage tailored to your specific medication needs.