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Why you may be paying more for your medications in 2016: Changes in 2016 prescription co-payments or cost-sharing designs

Your Medicare plan coverage · published Jan 29, 2016

Your Medicare Part D plan's cost-sharing structure (how the plan's formulary is divided into drug tiers and the cost-sharing per tier) directly influences your medication costs.  When a new drug tier is added into the design, the drugs on the previous tiers are moved, some to lower costing tiers and others to higher costing tiers.

Eighteen 2015 Medicare Part D plans changed their cost-sharing structure for 2016 prescription drug purchases. These plans include:  

Plan Name Nbr of
Cost-Sharing Tiers		 Members
2015 2016 2015 2016
Anthem Blue Cross MedicareRx Gold (PDP) 5 6 39,784 38,692
Anthem Blue Cross MedicareRx Plus (PDP) 5 6 40,883 39,935
Anthem Blue Cross MedicareRx Standard (PDP) 5 6 37,798 38,031
Anthem Blue MedicareRx Plus (PDP) 5 6 52,564 51,172
Anthem Blue MedicareRx Premier (PDP) 5 6 29,625 29,001
Anthem Blue MedicareRx Standard (PDP) 5 6 46,489 47,132
Asuris Medicare Script Basic (PDP) 5 6 5,513 5,323
Asuris Medicare Script Enhanced (PDP) 5 6 1,818 1,752
BCBSGa Blue MedicareRx Plus (PDP) 5 6 7,382 7,177
BCBSGa Blue MedicareRx Premier (PDP) 5 6 5,034 4,862
BCBSGa Blue MedicareRx Standard (PDP) 5 6 10,141 10,184
Blue MedicareRx Plus (PDP) 5 6 19,019 18,100
Blue MedicareRx Premier (PDP) 5 6 9,165 8,710
Blue MedicareRx Value (PDP) 5 6 15,988 15,469
Regence Medicare Script Basic (PDP) 5 6 3,678 3,507
Regence Medicare Script Enhanced (PDP) 5 6 1,253 1,222
SilverScript Choice (PDP) 4 5 3,298,354 3,810,908
SilverScript Plus (PDP) 4 5 124,563 123,544


For example, the SilverScript Choice plan added a "Preferred Generic" tier as Tier One and the former "Generic" tier will become Tier Two in 2016.

As can be seen in the following example, the 2015 SilverScript Choice plan formulary covered 671 medications as Tier One "Generic" medications (with an $8 co-pay).  In comparison, the 2016 SilverScript Choice plan formulary covers 102 medications as Tier One "Preferred Generics" (with an $3 co-pay) and 444 drugs as Tier Two "Generics" (with an $17 co-pay).

California SilverScript Choice
2015 and 2016 Medicare Part D plan Cost-sharing Comparison
2015 2016
Monthly Premium $22.20 $23.10
Initial Deductible $0 $0
Gap Coverage No Gap Coverage No Gap Coverage
Tier 2015
Cost-Sharing		 Drugs
on Tier		 Tier 2016
Cost-Sharing		 Drugs
on Tier
-- -- 1 Preferred Generic  $3 102
1 Generic $8 671 2 Generic $17 444
2 Preferred Brand $41 1,071 2 Preferred Brand $46 924
3 Non-Preferred Brand 43% 902 3 Non-Preferred Brand 47% 1,076
4 Specialty Tier 33% 399 4 Specialty Tier 33% 425
Total Formulary Drugs
Browse 2015 Formulary 3,043 Browse 2016
Formulary		 2,971

There were approximately 3,298,354 members in the 2015 SilverScript Choice plan and an additional 124,563 members in the SilverScript Plus plan that are seeing a similar change in their cost-sharing structure.

If you would like to learn how the Generics were sorted between the 2016 Generic and Preferred Generic tiers, you can click here to browser the California SilverScript Choice 2016 Formulary.

To compare annual changes in Medicare plans, our PDP-Compare and MA-Compare tools show the 2015 stand-alone Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MAs or MAPDs) across the country and include changes in plan features such as premium, deductible, cost-sharing and formulary size changes. Our compare tools also highlight plans that were merged, discontinued, or added in 2016.