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.



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).

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.


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.


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/2023.  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 (PDP-Finder.com/CA) or the Medicare Advantage Plan Finder (MA-Finder.com/90210).


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.