Open enrollment is your annual opportunity to choose (or switch) health insurance plans, and prescription drug coverage should be a major factor in your decision. This checklist helps you evaluate formularies, compare costs, and choose the plan that provides the best coverage for your specific medications.
Key Facts
Check Your Specific Plan's Formulary
Coverage varies by plan. Use our formulary checker tool to look up your exact copay and restrictions.
Open Formulary CheckerFrequently Asked Questions
ACA marketplace open enrollment runs November 1 to January 15 for 2026 coverage. Medicare Annual Enrollment is October 15 to December 7. Employer open enrollment periods vary by company, typically in October or November. Some states have extended marketplace enrollment periods. Mark these dates on your calendar.
Check these for each medication: Is it on the formulary? What tier is it on? What is the copay or coinsurance? Are there restrictions (PA, ST, QL)? Is your pharmacy in-network? Are 90-day supplies available? Does the plan have a specialty pharmacy requirement? Calculate total estimated annual drug costs including premiums.
It depends on your medications. If you take expensive specialty or brand-name drugs, a higher-premium plan with lower drug copays may save you money overall. If you only take cheap generics, a lower-premium plan usually wins. Add up total annual costs (premiums + estimated drug copays) for each option to find the best deal.
Related Resources
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