Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community
  • Menu
  • Home
  • Contact
  • MAPD
  • PDP
  • 2022
  • 2023
  • FAQs
  • Articles
  • Search
  • Contact
  • 2022
  • 2023
  • FAQs
  • Articles
  • Latest Medicare News
  • Search
Advertisement

Almost 3.8 million Medicare beneficiaries will see at least 100 more medications on their 2023 Medicare Part D drug plan formulary

Category: Annual Medicare Plan Changes
Published: Oct, 20 2022 10:10:36


Watch for annual Medicare drug plan formulary changes.

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 (and usually does) change their formulary or drug list, introducing or removing medications.

Although Medicare drug plans often reduce the size of their formularies year-to-year, almost 3.8 million Medicare beneficiaries currently enrolled in a 2022 Medicare Part D plan will see at least 100 medications added to their 2023 Medicare Part D drug plan's formulary.

The largest increase in a 2023 stand-alone prescription drug plan formulary size is the MedicareBlue Rx Premier (PDP) plan in PDP region 25 (IA, MN, MT, NE, ND, SD, and WY) with the addition of 415 specific prescription drug or drug NDCs bring their formulary size up to 3,483 drugs in 2023 - up from 3,068 drugs in 2022.

Alternatively, only 123,442 members are currently enrolled in a stand-alone 2022 Medicare Part D prescription drug plan that will see a 2023 reduction of at least 100 medications from their current plan formulary.  For example, the SecureRx - Option 1 (PDP) in PA and WV will lose 362 "NDCs" from their formulary.

A note about "NDCs" and determining the size of a formulary

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 drug packaging.  The NDC for your personal prescription medication appears on the label of your prescription bottle. (Please note:  Throughout this article, we use the terms "drugs", "medications", and "NDCs" interchangeably.)  You can click here to see the Q1Rx Drug Finder results of the graphic below:

Q1Medicare Q1Rx Drug Finder with specific NDC

Changes in the largest 2022 Medicare Part D formularies for 2023

Here are several further examples of 2022 stand-alone Medicare Part D plans with the largest formularies and how their formularies are changing in 2023.  (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).

2022 Medicare Part D Plans with the
Largest Formularies and Change for 2023
Plan Name 2023 Formulary Size
2022 Formulary Size Change
in Size
Members Affected
AR BlueMedicare Premier Rx (PDP) 4,413 4,367 46 5,494
PA WV Blue Rx PDP Complete and Plus plans 4,141 4,160 -19 19,864
CA SilverScript SmartRx (PDP) 3,630 3,586 44 1,455,393
PR AARP MedicareRx Preferred (PDP) 3,624 3,571 53 12,698
PA WV SecureRx - Option 1 (PDP) 3,177 3,539 -362 3,390
IL Blue Cross MedicareRx Value (PDP) 3,483 3,502 -19 128,963
NJ Horizon Medicare Blue Rx Enhanced (PDP) 3,483 3,502 -19 14,520
AZ Banner Medicare Classic Rx and Premier Rx plans 3,178 3,499 -321 2,945
FL BlueMedicare Complete Rx (PDP) 3,534 3,486 48 6,693
NC Blue Medicare Rx Enhanced (PDP) 3,483 3,454 29 27,149
FL Wellcare Medicare Rx Value Plus (PDP) 3,419 3,449 -30 490,760


As in past years, although many of the largest 2022 drug plan formularies shown in the table above are offered by "Blue" plans, several of the 2023 Medicare Part D plans with the smallest formularies are also Blue plans.

Important note about the size of a formulary:  A “larger” or “smaller” formulary does not necessarily reflect on the quality or coverage of the Medicare drug plan.  Your goal when choosing a Medicare drug plan for next year is to find a Medicare plan that offers the most affordable coverage for your specific 2023 health and prescription needs.

2023 Medicare Part D Plans with the
Smallest Formularies
Plan Name 2023 Formulary Size
2022 Formulary Size Change
in Size
Members Affected
MI Prescription Blue Select (PDP) 2,845 2,768 77 3,470
AZ Amerivantage Rx Basic (PDP) 2,912 2,930 -18 470
CA Anthem Blue Cross MediBlue Rx Standard (PDP) 2,912 2,930 -18 37,177
CO Anthem MediBlue Rx Standard (PDP) 2,912 2,930 -18 41,782
KS Blue MedicareRx Value (PDP) 2,912 2,930 -18 11,289
NY Blue Rx Standard (PDP) 2,912 2,930 -18 630
OR WA Asuris Medicare Script Basic (PDP) 2,939 2,806 133 2,578
IL Blue Cross MedicareRx Basic (PDP) 2,939 2,837 102 57,707
NC Blue Medicare Rx Standard (PDP) 2,939 2,720 219 7,595
FL BlueMedicare Premier Rx (PDP) 2,939 2,720 219 46,386
AR BlueMedicare Value Rx (PDP) 2,939 2,732 207 14,507
NJ Horizon Medicare Blue Rx Standard (PDP) 2,939 2,720 219 5,902
IA MN MT NE ND SD WY MedicareBlue Rx Standard (PDP) 2,939 3,068 -129 115,950

How to see how your current formulary is changing in 2023?

Our PDP-Compare and MA-Compare tools highlight coverage changes for each stand-alone Medicare Part D prescription drug (PDP) and Medicare Advantage (MA or MAPD) plan and include 2022 / 2023 changes in plan features such as premium, deductible, cost-sharing and formulary size changes.

Size of a Formulary changing year to year

You can click on the "2022 Formulary" or "2023 Formulary" link in the PDP-Compare or MA-Compare to review the plan's actual formulary.

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.

You can also find the "Browse Formulary" link on the results list within our Medicare Part D Plan Finder (https://PDP-Finder.com/CA) or the Medicare Advantage Plan Finder (https://MA-Finder.com/90210).

Q1Medicare Formulary Browser

Comparing drug costs across Medicare plans

Our Drug Finder is available at Q1Rx.com/2023. 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 50 Medicare Advantage plans available in Allegheny County, PA (ZIP: 15228) that cover Advair Diskus MIS 250/50 in 2023.

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 2023 Medicare Part D and Medicare Advantage plans that most affordably meet their health and prescription needs.







Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs


Advertisement



Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.

Advertisement

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.