Q1Group 2018 Drug Plan Analysis: Examples of how 2018 Medicare Part D plans can change prescription cost-sharing designs

As in past years, some 2017 Medicare Part D plans are changing their cost-sharing designs for 2018 prescription drug purchases. For example, the EnvisionRxPlus (PDP) plan in many states will change their generic drug tiers from co-insurance (a percentage of the drug cost) to copay (a flat fee) in 2018.

As can be seen in the following example, the 2017 EnvisionRxPlus plan formulary covers 312 medications as Tier One "Generic" medications (with an 10% co-insurance). In comparison, the 2018 EnvisionRxPlus plan formulary covers 124 medications as Tier One "Preferred Generics" (with an $1 co-pay) and 573 drugs as Tier Two "Generics" (with an $3 co-pay).

Illinois EnvisionRxPlus 2017 and 2018 Medicare Part D plan Cost-sharing Comparison
2017			2018
Monthly Premium		$29.00			$26.80
Initial Deductible		$400			$405
Gap Coverage		No Gap Coverage			No Gap Coverage
Tier	2017 Cost-Sharing			Drugs on Tier	Tier	2018 Cost-Sharing		Drugs on Tier
1	Preferred Generic		10%	312	1	Preferred Generic	$1	124
2	Generic		12%	532	2	Generic	$3	573
3	Preferred Brand		15%	259	3	Preferred Brand	15%	392
4	Non-Preferred Drug		33%	1,539	4	Non-Preferred Drug	30%	1,076
5	Specialty Tier		25%	565	5	Specialty Tier	15%	515
Total Formulary Drugs	Browse 2017 Formulary			3,207	Browse 2018 Formulary		3,015

There are approximately 94,485 members in the 2017 EnvisionRxPlus plan who will see this change. Members in the Mississippi EnvisionRxPlus will see their cost-sharing Tier 2 Generics change to a $6 copay.

An additional 250,021 members in the 2017 EnvisionRxPlus (ex: PA) plan will see their Tier 3 Preferred Brand cost-sharing change from 10% co-insurance to a copay of $29 ($34 in Oregon and Washington State).

In total, 808,765 members of various stand-alone Medicare Part D plans will see one or more of the drug tiers change cost-sharing from either coinsurance to copay or copay to coinsurance.

To compare annual changes in Medicare plans, our PDP-Compare and MA-Compare tools show the 2017 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 2018.

Not sure where to begin with choosing your Medicare Part D plan?
Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak with a Medicare representative, and learn more about their 2018 Medicare Part D or Medicare Advantage plan options.