January is already in the mail
The new updates to Medicare Advantage and Part D plans, called the 2027 Annual Notice of Change, landed in mailboxes around the country on September 30th. Those letters detail the changes that members will experience starting on January 1, including premium increases, network updates, and shifts in drug coverage.
Most members will file it away. Nearly 7 in 10 people on Medicare skip comparing plans during open enrollment, according to KFF research, and members who stay put roll into next year’s plan whatever it costs or covers. For pharmacy and medical directors, that makes the ANOC the clearest early map of 2027 therapy disruption.
2027 raises the stakes
This year’s letters carry extra weight. CMS ended the Part D Premium Stabilization Demonstration a year early, closing the temporary subsidy that held down stand-alone drug plan premiums in 2025 and 2026. The core benefit numbers moved too.
| Part D benchmark | 2026 | 2027 |
|---|---|---|
| Maximum standard deductible | $615 | $700 |
| Annual out-of-pocket cap | $2,100 | $2,400 |
| Base beneficiary premium (monthly) | $38.99 | $41.33 |
The base beneficiary premium is the benchmark CMS uses to calculate each plan’s premium. What members will eventually pay varies plan by plan. CMS projects the average stand-alone Part D premium will rise less than $1, from $35.09 to $36. A dollar doesn’t sound like much, but averages hide the spread. Avalere warns that ending the stabilization will add upward pressure on stand-alone premiums and could accelerate market shifts. The stand-alone market is already shrinking, with 323 offerings for 2027, down from 367.
Plan churn speeds the shift. For example, Humana is exiting Medicare Advantage plans that cover roughly 600,000 members and expects to recapture only about 40% of them into its other plans. Hundreds of thousands of seniors will start January on a new formulary, with a new plan that starts from a blank claims history.
All of these changes (higher deductibles and premiums, shifting drug coverage, and forced plan changes) will land at the same time on January 1. That is only three weeks after open enrollment stops on December 7.
When coverage changes become a clinical event
Every January, the pharmacy counter becomes the front line of medical care frustration. Members face surprise rejected claims, new prior authorization flags, and a big new price tag on a needed chronic medication. The patient calls their physician, who then scrambles for an alternative, playing a game of prescribe and pray not knowing what formulary changes occurred. A tier move that doubles a copay or a new step therapy rule on a drug a patient has taken for years lands the same way.
The health consequences of these sudden changes play out in predictable ways. One in six members will stop therapy or start rationing pills. For members on maintenance therapy for chronic conditions like diabetes, heart failure, COPD, and mental health, a gap of even a few weeks carries real health and cost consequences. Polypharmacy patients face even greater exposure, since one plan change can touch several of their prescriptions at once.
The good news is that this annual frustration can be avoided. Every one of the members who will experience a shock is identifiable today. All that needs to happen before January 1 is to match the ANOC changes against current claims, and the January disruption becomes a smooth transition.
The data on what happens next
Our research shows exactly where unmanaged coverage changes end up.
In the RazorMetrics 2026 Physician Drug Cost Survey, 96% of physicians said a patient had stopped a medication over cost without telling them. That silence is the core clinical danger of a January formulary change. The gap in therapy stays invisible until it surfaces as an ER visit or a worsening lab.
Prescribers carry the administrative load too. 84% of practices field five or more patient calls a week about high-cost prescriptions, and 72% of physicians spend five or more hours a week on prior authorization alone. Every restriction added in 2027 feeds those queues.
Patients confirm the pattern. In the RazorMetrics 2026 State of Drug Access Survey, 46% of insured consumers said they would call their doctor when a prescription costs too much.
The same research points to the fix. 95% of physicians are comfortable switching a patient to a lower-cost, clinically appropriate alternative. Nearly 90% of patients say they will accept and fill a switch their physician initiates, and 84% want their provider to choose the lower-cost option automatically. Physicians are ready. Patients are ready. What’s missing is the right recommendation reaching the prescriber at the right time.
Four moves before January 1
Pharmacy and medical directors have about 11 weeks. Use every week to accomplish the following:
- Build the impact list. Cross-reference every 2027 formulary removal, tier change, and new utilization management rule against current claims. The output is a named list of members who will feel a change on January 1.
- Rank by clinical risk. Put maintenance therapies with narrow tolerance for gaps at the top: insulin, anticoagulants, anticonvulsants, inhalers, antipsychotics. Flag polypharmacy members hit by more than one change.
- Start with the prescriber. Reach physicians now with the specific member, the specific change, and a covered alternative. A switch decided in November by the doctor who knows the patient beats a rejected claim in January.
- Clear authorizations early. Submit transition prior authorizations and exceptions for members who should stay on their current therapy, well ahead of the December rush.
Each move protects members, physicians, and pharmacists from a January shock. It protects member satisfaction at the start of the year. And it keeps members on therapy, which keeps them out of the hospital.
Four moves, zero lift
Running those four moves across an entire Medicare book is a tall order for a team already deep in open enrollment. This is where RazorMetrics can help.
Our technology screens 100% of your members’ claims against your 2027 formulary, plan rules, and preferences, then flags every member a January change will touch. Each prescriber receives a specific, clinically appropriate recommendation inside the workflow they already use, along with a full view of everything that patient takes, including duplications and potential interactions. The physician makes the call. The member hears it from their own doctor.
That physician-first design earns a 76% physician response rate, and it turns January’s coverage changes into savings and happier members. Every new RazorMetrics client starts saving within 120 days, backed by a guaranteed 2X ROI in year one. Implementation costs nothing, requires no integration, and deploys in under 60 days.
October decides January
The same logic that applies to MA plans is appropriate for every line of business. Commercial and employer formularies reset on January 1 too, and those plans are locking in their own 2027 changes right now. The Medicare ANOC simply puts the whole map on paper, on a federal deadline, for everyone to see.
Plans that read it as a clinical risk signal will gain months of runway. Plans that wait will experience the same roller coaster ride in January, one rejected claim at a time.
Talk to RazorMetrics about building your 2027 impact list before open enrollment closes.
