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

Very few Medicare Part D plans keep their cost-sharing (co-payments and/or co-insurance) the same from year to year. Rather, your portion of your prescription costs has a tendency to rise. Some prescription drug plans have increased their cost-sharing more than others.

For example, the 2016 WellCare Simple (PDP) plan

increased the co-payments for tiers one, two, and three;
changed tier four from co-payment to co-insurance; and
increased the co-insurance on tier 5 Specialty drugs.

WellCare Simple in Virginia 2015 and 2016 Medicare Part D plan Cost-sharing Comparison
2015			2016
Monthly Premium		$31.90			$37.10
Initial Deductible		$320			$360
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		$0	289	1	Preferred Generic	$8	323
2	Non-Preferred Generic		$2	893	2	Generic	$20	395
3	Preferred Brand		$40	896	3	Preferred Brand	$47	866
4	Non-Preferred Brand		$88	621	4	Non-Preferred Brand	50%	771
5	Specialty Tier		25%	427	5	Specialty Tier	33%	446
Total Formulary Drugs	Browse 2015 Formulary			3,135	Browse 2016 Formulary		2,801

In reviewing the above example...

Tier 1 preferred generic drug purchases that were free ($0) in 2015 will now cost members $8 as the pharmacy.
Tier 2 non-preferred generics that cost $2 in 2015 will cost $20 in 2016.
Tier 3 preferred brand-name drugs will cost $7 more in 2016 as compared to 2015.
Tier 4 non-preferred brand-name drugs that have a retail price less than $176 will cost less in 2016 using the 50% co-insurance rather than the $88 co-pay from 2015. Example: a $120 prescription will only cost $60 rather than $88. However, prescriptions with a retail price over $176 will cost more in 2016. A $300 prescription will cost $150 using the 50% co-insurance rather than the $88 that it cost in 2015.
Tier 5 specialty medications will cost 8% more than they did in 2015.

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 will be merged, discontinued, or added in 2016.