As in past years, some 2022 Medicare Part D plans are changing their
cost-sharing designs for 2023 prescription drug purchases - and such changes will affect what you pay when purchasing formulary drugs at a network pharmacy.
Cost-sharing
is what you will pay for your Medicare Part D formulary drugs and can
be either a fixed-copay (Tier 3 drugs are a $47 co-pay) or cost-sharing
can be a percentage of the drug's retail cost (25% of the retail drug price).
Adding to or changing your Medicare Part D plan's formulary drug tiers
Each
year, Medicare drug plans can also change the structure of the plan's
formulary or drug list and add (as in the example below) - or take away - formulary tiers - or the
plan can move drugs from one Tier to another.
As an example, the 2023
Wellcare Value Script plan will change from a five (5) drug tier formulary to a six (6) tier cost-sharing structure in all states, as shown in the chart below.
California Wellcare Value Script (PDP)
2022 and 2023 Medicare Part D plan Cost-sharing Comparison
|
|
2022 |
2023 |
Monthly Premium |
$10.90 |
$8.30 |
Initial Deductible |
$480 (Tier 1 and 2 excluded from the deductible.) |
$505 (Tier 1 and 2 excluded from the deductible.) |
Gap Coverage |
No Gap Coverage |
No Gap Coverage |
Tier |
2022
Cost-Sharing |
Drugs
on Tier |
Tier |
2023
Cost-Sharing |
Drugs
on Tier |
1 |
Preferred Generic |
$0 |
342 |
1 |
Preferred Generic |
$0 |
322 |
2 |
Generic |
$4 |
438 |
2 |
Generic |
$5 |
402 |
3 |
Preferred Brand |
$42 |
1,037 |
3 |
Preferred Brand |
$44 |
1,005 |
4 |
Non-Preferred Drug |
47% |
962 |
4 |
Non-Preferred Drug |
47% |
999 |
5 |
Specialty Tier |
25% |
693 |
5 |
Specialty Tier |
25% |
637
|
- |
- |
- |
- |
6 |
Select Diabetic Drugs |
$11 |
43
|
Total Formulary Drugs
|
Browse 2022
Formulary |
3,472 |
|
Browse 2023
Formulary |
3,408 |
Question: What do these 2022 / 2023 plan changes mean to you?
- There are fewer drugs that will be excluded from the deductible (fewer drugs on Tier 1 and Tier 2).
- Tier 2 generics will be slightly more expensive in 2023.
- The cost of Tier 3 preferred brand drugs will be slightly more expensive in 2023 - and this tier has the largest number of drugs.
- The cost-sharing for Tier 4 and Tier 5 drugs will remain the same (but, the 2023 formulary can have your drugs on different tiers as compared to 2022 - or possibly no longer cover your higher-tier drugs).
- Select Diabetic Drugs will have an $11 copay.
- You can also see from the chart that the number of drugs being
covered by this plan is decreasing by 64 - and you will want to review the formulary (FormularyBrowser.com) or contact
your 2022 plan to ensure that your medications are still covered by the
2023 plan.
Changing the cost-sharing for a formulary tier
In another
example, the 2022 California SilverScript SmartRx (PDP) plan
formulary covers 799 medications as Tier 3 "Preferred Brand"
medications (with a
$46 copay). In 2023, the SilverScript SmartRx will become the SilverScript SmartSaver and Tier 3 "Preferred Brand"
will have a
25% coinsurance.
California SilverScript SmartSaver (PDP)
2022 and 2023 Medicare Part D plan Cost-sharing Comparison
|
|
2022 |
2023 |
Monthly Premium |
$7.50 |
$4.50 |
Initial Deductible |
$480 (Tier 1 excluded from the deductible.) |
$505 (Tier 1 excluded from the deductible.) |
Gap Coverage |
No Gap Coverage |
No Gap Coverage |
Tier |
2022
Cost-Sharing |
Drugs
on Tier |
Tier |
2023
Cost-Sharing |
Drugs
on Tier |
1 |
Preferred Generic
|
$1 |
250 |
1 |
Preferred Generic |
$2 |
250 |
2 |
Generic |
$19 |
611 |
2 |
Generic |
$15 |
1,173 |
3 |
Preferred Brand |
$46 |
799 |
3 |
Preferred Brand |
25% |
225 |
4 |
Non-Preferred Drug |
49% |
1,370 |
4 |
Non-Preferred Drug |
50% |
1,394 |
5 |
Specialty Tier |
25% |
599 |
5 |
Specialty Tier |
25% |
588 |
Total Formulary Drugs
|
Browse 2022
Formulary |
3,629 |
|
Browse 2023
Formulary |
3,630 |
Question: What do these 2022 / 2023 plan changes mean to you?
- Your Tier 1 medications will be slightly more expensive.
- Your Tier 2 medications will be less expensive
- The change from a $46 co-pay to a 25% of retail cost-sharing means
that you will pay less for your Tier 3 medications that have a retail price of under $184, but you will pay more for your Tier 3 medications that have a retail costs over $185 - and Tier 3 contains the largest number of formulary drugs.
- You will pay slightly less for your Tier 4 medications in 2023.
Question: How many people will be affected by these 2022 / 2023 plan changes?
There are approximately
1,455,393 members in the
2022 SilverScript SmartRx (PDP) who will see similar changes in their plan
coverage.
In total,
2.4 million members of various stand-alone Medicare
Part D plans will see one or more of the drug tiers change cost-sharing
from either coinsurance (such as 15%) to copay (such as $35) or copay to
coinsurance.
To compare annual changes in Medicare plans, our
PDP-Compare
and
MA-Compare
tools show the 2023 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 or discontinued and new plans being added in 2023.
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 2023 Medicare
Part D or Medicare Advantage plan options.