Yes — most private insurance plans reset in January, and this reset can directly affect how much you pay for prescriptions. Even if a medication was covered last year, coverage rules, deductibles, or limits may restart at the beginning of the new year.
Understanding this reset can help you avoid surprise costs at the pharmacy.
What Does “Insurance Reset” Mean?
An insurance reset usually means that certain parts of your benefits return to their starting point at the beginning of the calendar year.
This may include:
- annual deductibles restarting
- coverage limits resetting
- prior authorizations expiring
- new formulary rules taking effect
This is why January often feels more expensive for prescriptions.
Why Your Prescription May Cost More in January
Even if you didn’t change your insurance plan, January costs can increase because:
- deductibles must be met again
- coverage caps reset to zero
- some medications require re-approval
This is especially common for:
- specialty medications
- weight loss medications
- biologics
- long-term treatments
Does OHIP Reset in January?
OHIP itself does not operate like private insurance plans.
However, OHIP-funded drug programs may:
- reassess eligibility annually
- require updated documentation
- follow calendar-year rules
This is why some patients notice changes at the start of the year.
What You Can Do to Avoid Surprise Costs
Before refilling a prescription in January:
- review your insurance plan summary
- ask whether deductibles apply
- confirm coverage for high-cost medications
- check if re-authorization is required
A pharmacist can help clarify this before you commit to a refill.
Checking coverage early can prevent surprises
Insurance resets are common in January
Deductibles and limits often restart
January costs can be higher even without plan changes
