Yes, your drug costs can exceed $2,000 on a Medicare Part D plan if the drug is not on your plan’s formulary (the list of covered drugs). The $2,000 out-of-pocket cap (starting in 2025) only applies to covered drugs.
What Happens If a Drug Is Not on the Formulary?
- You Pay Full Price – If a medication is not on your plan’s formulary, Medicare does not cover it, and you must pay the full retail price. This cost will not count toward the $2,000 out-of-pocket cap.
- Exceptions & Appeals – You can request a formulary exception from your plan. If approved, your plan may cover the drug, and your costs would then count toward the cap.
- Switching Plans – If you regularly take a non-formulary drug, you may want to look for a Part D plan that does cover it during open enrollment (Oct 15 – Dec 7 each year).
To avoid high costs, check your plan’s formulary list each year or talk to your doctor about alternative covered medications.