Plan discontinued · San Diego County, California

Sharp Direct Advantage Ending: Are My Prescriptions Covered?

Your prescriptions do not end with the plan. The doctor's orders are still good and your pharmacy still has them on file. What ends on December 31 is the drug coverage that came inside Sharp Direct Advantage, and that part does not replace itself. Here is what changes for your medicines on January 1, 2027, what the CMS plan file shows for San Diego County, and the checks worth doing before you pick anything.

Medicare On Main Data Desk

Published October 11, 2026 · 9 min read · Reviewed by Brian Penner

The four individual Sharp Direct Advantage plans, Gold, Platinum, VIP and VIP Plus, had 17,247 San Diego County members in September, and none of the four appears in the CMS plan file for 2027. The first post in this series covers what the file shows, and the doctors post covers the question most people ask first. This one is about the question they ask second, usually while holding a pill bottle. The plan is being discontinued. Sharp's doctors and hospitals are not, your prescriptions are not, and no one is losing Medicare.

What ends, and what does not

A prescription is an order from your doctor. It is not tied to an insurance plan, and it does not expire because a plan does. Refills remaining on a prescription in December are still there in January. What changes is who pays the pharmacy.

Sharp Direct Advantage was a Medicare Advantage plan with Part D drug coverage built in, so the medical plan and the drug plan end together. From January 1 your drugs are paid for by one of two things:

• A new Medicare Advantage plan that includes drug coverage. One enrollment covers both. San Diego County has 41 general plans of this kind for 2027. Five other plans in the county are medical-only and carry no drug coverage, so read the plan name for "No Rx" or ask before you enroll.
• A stand-alone Part D plan, beside Original Medicare. If you return to Original Medicare, with or without a Medigap policy, the drug plan is a separate enrollment. Medigap policies sold today do not cover prescriptions.

If you do neither, you are in Original Medicare on January 1 with no drug plan, and you pay the pharmacy's full price until you enroll in one. What happens if I do nothing walks through that default.

What changes on January 1, in any plan

Sources: CMS CY2026 and CY2027 landscape files, compared by Contract Plan ID; Medicare.gov, Costs for Medicare drug coverage. Read October 11, 2026.

Two of those rows are Medicare's and apply to every plan in the country. Medicare.gov states them this way: "No Medicare drug plan may have a deductible more than $700 in 2027 ($615 in 2026), and some plans have no deductible," and you pay your share "until your out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 ($2,400 in 2027)." After that, "You won't have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year."

The phrase that matters is "calendar year." If you reached your cap in 2026, or came close, that count goes back to zero on January 1. This would have happened if Sharp Direct Advantage had continued, and it happens in every plan you could choose. The plan ending does not cost you progress toward a cap. The new year does.

Drug deductibles in San Diego County for 2027

The CMS plan file lists the yearly Part D deductible for every plan. Sorting San Diego County's 41 general Medicare Advantage drug plans by that one column gives this:

Source: CMS CY2027 landscape file, San Diego County, Medicare Advantage plans with drug coverage, excluding Special Needs Plans. Organization names are factual reporting from the file, not a recommendation.

Three things to take from the table. First, a $0 premium says nothing about the drug deductible: plans at $0 a month appear in every row, from $0 to $700. Second, the three UHC Sharp Medicare Advantage plans (CA-001P, ValueRx CA-12P and CA-026P) list $355, which is $5 above what Sharp Direct Advantage members had in 2026. The rest of that comparison is in Sharp Direct Advantage vs. UHC Sharp Medicare Advantage. Third, every one of the 29 plans with a deductible is flagged in the file as offering a drug tier that the deductible does not apply to, as all four Sharp plans were in 2026. In practice that often means lower-tier generics, but the file does not say which tier, so read each plan's Summary of Benefits before you count on it.

A deductible is one number. If you take two generics, a $700 deductible that skips the generic tiers may never touch you. If you take one brand-name drug, it can be the largest drug bill of your year, and it arrives in January.

What the file cannot tell you, and where to look

The landscape file has premiums, deductibles and caps. It has no drug lists, no tiers, no copays and no pharmacies. Those four are what decide your cost, and they are different in every plan. The checks, in order:

1. Is each drug on the plan's 2027 drug list? Enter every medicine by name, strength and how often you take it in Medicare Plan Finder, or read the plan's formulary. Do not assume a drug is covered because it was in 2026.
2. Which tier is it on? The same drug can sit on a lower tier in one plan and a higher one in another, and the tier sets the copay.
3. Does the plan attach a rule to it? Medicare.gov describes three. "Prior authorization is approval based on a plan's specific requirements." "Step therapy is a type of prior authorization that requires you first to try a certain, less expensive drug." And "Plans may limit the amount of drugs they cover over a certain time period, for safety and cost reasons." An approval Sharp Health Plan gave you was that plan's decision. Ask the new plan what it needs, and ask your prescriber's office to be ready to send it.
4. Is your pharmacy in the network, and is it preferred? Network pharmacies "have agreed to offer a discounted price for members of certain Medicare plans," preferred pharmacies "may save you money on your out-of-pocket drug costs (like a copayment or coinsurance)," and out-of-network pharmacies "usually offer drugs at a higher cost" (Medicare.gov, Pharmacies). If you fill at a pharmacy inside a medical group's building, look that specific location up in the directory.

Bring your pill bottles or a pharmacy printout to this step. Spelling and strength matter, and "the little white one for blood pressure" cannot be looked up.

If a drug is not on your new plan's list

Federal rules give you a bridge. Under 42 CFR § 423.120(b)(3), "A Part D sponsor must provide for an appropriate transition process for enrollees prescribed Part D drugs that are not on its Part D plan's formulary." The rule names "new enrollees into Part D plans following the annual coordinated election period," which is what a Sharp member joining a plan this fall will be, and it requires the plan to:

• "Ensure access to a temporary supply of drugs within the first 90 days of coverage under a new plan";
• provide "a one-time, temporary supply of at least an approved month's supply of medication" when you ask for a fill of a drug that is not on its list;
• send written notice "within 3 business days after adjudication of the temporary fill."

Read the limits as carefully as the right. It is one fill. It exists so you are not without a medicine while you and your doctor sort out what comes next, and the notice that follows it explains your choices. Those are to change to a drug the plan covers, or to ask for an exception, which Medicare.gov defines as "when a drug plan decides to cover a drug that's not on its drug list, or to waive a coverage rule." Your prescriber can make that request. A plan's Evidence of Coverage describes how its own transition supply works, including how you pay for it. The better outcome is never to need one, which is what the checks above are for.

If you go back to Original Medicare

Some Sharp members will use this year's guaranteed right to a Medigap policy; can I get Medigap without health questions in California? covers that door. On that route the drug plan is its own purchase. The 2027 file lists 10 stand-alone Part D plans for California:

Source: CMS CY2027 landscape file, California stand-alone Part D plans, sorted by premium. Plan names are factual reporting from the file, not a recommendation.

The same four checks apply. A low premium with a $700 deductible and your drug on a high tier can cost more over the year than a higher premium without them. The premium is the only number on this table you are certain to pay.

Timing matters here more than anywhere else in the series. Medicare.gov says the Part D late enrollment penalty can apply after "a period of 63 or more days in a row when you don't have Medicare drug coverage" or other creditable coverage, and it is figured at 1% of the national base beneficiary premium ($38.99 in 2026) for each full month you went without. Counting from December 31, 2026, day 63 is March 4, 2027. Enroll during the October 15 to December 7 Annual Enrollment Period and your drug plan starts January 1 with no gap at all. The Special Enrollment Period for a discontinued plan runs December 8 through February 28, but CMS's 2027 enrollment guidance starts coverage the month after your request: a January request means February 1, and a January spent paying full price at the counter.

What I would do about prescriptions this month

1. Make the list. Every drug, with strength and how often, plus the pharmacy you use. Ask the pharmacy for a printout if that is easier.
2. Mark the ones that needed an approval. If Sharp Health Plan required prior authorization or an exception for a drug, flag it. Those are the ones to ask a new plan about first.
3. Run the list against two or three 2027 plans that already passed your doctor check. Compare the year's total drug cost, not the premium.
4. Enroll by early December so the member card and its pharmacy numbers arrive before January 1. The dates post has the full calendar.
5. Ask your pharmacist in early December which refills are eligible before the 31st, and fill them under your current plan.
6. If you spread your drug costs monthly through the Medicare Prescription Payment Plan, ask the new plan how to set it up there. Medicare.gov notes that "participation is voluntary" and that it "doesn't save you money or lower your drug costs."
7. Carry the new card to your first January fill. If the pharmacy says a drug is not covered, ask about the transition supply and call the plan from the counter.

How we know all this: the Medicare On Main Data Desk frames every article with public data — here, the CMS CY2026 and CY2027 landscape files compared by Contract Plan ID, the CMS September 2026 enrollment file by contract, plan and county, Medicare.gov's Costs for Medicare drug coverage, Drug plan rules, Pharmacies, Part D late enrollment penalty and Medicare Prescription Payment Plan pages, 42 CFR § 423.120(b)(3) as published by Cornell's Legal Information Institute, and the CMS CY 2027 Enrollment and Disenrollment Guidance, all read October 5 through October 11, 2026. The landscape file does not contain any plan's formulary, drug tiers, copays or pharmacy network, so none is stated here; each plan's own 2027 documents and Medicare Plan Finder govern. Carrier, plan and health-system names are factual reporting, not endorsement; the plan is being discontinued and no member is losing Medicare. Medicare On Main is a licensed independent insurance agency. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program. This is education, not advice; confirm your own drugs, costs and dates with the plan, a licensed agent or Medicare.gov, and ask your doctor or pharmacist before changing how you take any medicine.