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Over 1.1 million Medicare beneficiaries will see at least 100 fewer medications on their 2022 Medicare Part D drug plan formulary

Category: Annual Medicare Plan Changes
Published on 2021-10-16 14:09:04

With each new plan year - and throughout the plan year - your Medicare Part D plan (PDP) or Medicare Advantage plan that provides prescription coverage (MAPD) can change their formulary or drug list, introducing or removing medications.

As a note: The size of a Medicare Part D prescription drug plan formulary is measured in NDCs or National Drug Codes.  These 11-digit codes are used by doctors and pharmacies to uniquely identify a medication, the strength, and the packaging.  The NDC for your medication appears on the label of your prescription bottle. (Throughout this article, we use the terms drugs, medications, and NDCs interchangeably.)

The largest increase in stand-alone prescription drug plan formulary size is the SilverScript Plus plan with the addition of 200 NDCs bring their formulary size up to 3,260 in 2022 from 3,060 in 2021.

However, over 2 million members of stand-alone Medicare Part D prescription drug plans will see a reduction of at least 100 medications from their current plan formulary.  For example, the BlueMedicare Complete Rx (PDP) will lose 844 NDCs from their formulary.

Changes in the largest 2021 Medicare Part D formularies for 2022

Here are several examples of 2021 stand-alone Medicare Part D plans with the largest formularies and how their formularies are changing in 2022.  (Again, the formulary size in the chart below is measured in NDCs or National Drug Codes - used by pharmacies to uniquely identify a medication, the strength, and the packaging).

2021 Medicare Part D Plans with the
Largest Formularies and Change for 2022
Plan Name 2022 Formulary Size
2021 Formulary Size Change
in Size
Members Affected
AL TN BlueRx Enhanced Plus (PDP)4,3674,3303717,475
FL BlueMedicare Complete Rx (PDP)3,4864,330-8447,058
PA WV Blue Rx PDP Plus (PDP)4,1604,185-2514,158
PA WV Blue Rx PDP Complete (PDP)4,1604,185-258,202
AZ Blue MedicareRx Enhanced (PDP)2,8343,578-7441,056
SilverScript SmartRx (PDP)3,5863,56422718,886
AARP MedicareRx Preferred (PDP)3,5713,523481,768,090
PA WV SecureRx - Option 1 (PDP)3,5393,478612,287
Wellcare Value Script (PDP)3,4353,466-31782,989
NJ Horizon Medicare Blue Rx Enhanced (PDP)3,5023,4574514,620

Although many of the largest 2021 drug plan formularies shown in the table above are offered by "Blue" plans, several of the 2022 Medicare Part D plans with the smallest formularies are also Blue plans.

2022 Medicare Part D Plans with the
Smallest Formularies
Plan Name 2022 Formulary Size
2021 Formulary Size Change
in Size
Members Affected
NC Blue Medicare Rx Standard (PDP)2,7202,749-298,165
AR BlueMedicare Premier Rx (PDP)2,7202,749-2956,196
NJ Horizon Medicare Blue Rx Standard (PDP)2,7202,675456,740
AR BlueMedicare Value Rx (PDP)2,7322,6755716,527
MI Prescription Blue Select (PDP)2,7682,819-514,955
AL TN BlueRx Essential (PDP)2,8062,7495714,399
ID UT Regence Medicare Script Basic (PDP)2,8062,749571,886
OR WA Asuris Medicare Script Basic (PDP)2,8062,749572,900
PA WV SecureRx - Option 3 (PDP)2,8062,749571,670
AZ Blue MedicareRx Enhanced (PDP)2,8343,578-7441,056

Please remember:  A “larger” or “smaller” formulary does not necessarily reflect on the quality of the Medicare plan. Your goal is to find a Medicare plan that offers the most affordable coverage for your 2022 health and prescription needs.

Browsing any Medicare plan’s formulary

Our Formulary Browser for both stand-alone Medicare Part D plans and Medicare Advantage plans (MAPDs) can be found at Formulary-Browser.com.  Using the Formulary Browser, you can browse by letter though each plan’s entire formulary to review cost-sharing and the details of the drug’s utilization management restrictions such as quantity limits, prior authorization, and step therapy. Quantity limits are displayed as Q:30/90days meaning that this drug has a quantity limit of 30 units (such as “tablets”) for a 90 day period.

Comparing drug costs across Medicare plans

Our Drug Finder is available at Q1Rx.com/2022. Similar to our Formulary Browser, our Drug Finder displays the cost-sharing and details of the utilization management restrictions, but in the Drug Finder, this information is shown for a particular drug across all plans in your chosen service area. As an example, click here to see the 40 Medicare Advantage plans available in Allegheny County, PA (ZIP: 15228) that cover Advair Diskus MIS 250/50. Once you are on the Drug Finder page, you can change the ZIP code to your ZIP and change the drug to your medication.

For a stand-alone Medicare prescription drug plan example, click here to review the 21 Medicare Part D drug plans available in Pennsylvania that cover Advair Diskus MIS 250/50. Again, change the state to your state once you are on the Drug Finder page.

Need help finding the Medicare plan with the most affordable coverage?

Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak with a Medicare representative, and learn more about 2022 Medicare Part D and Medicare Advantage plans that most affordably meet their health and prescription needs.

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Tips & Disclaimers
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