Annual Medicare drug plan changes: Examples of how 2022 Medicare Part D plans change formulary cost-sharing.

As in past years, some 2021 Medicare Part D plans are changing their cost-sharing designs for 2022 prescription drug purchases. 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 retail). Each year, Medicare drug plans can also change the structure of the plan's formulary or drug list and add - or take away - formulary tiers - or the plan can move drugs from one Tier to another.

Adding new formulary drug tier - For example, the Prescription Blue Select plan will change from a single drug tier for all formulary drugs to a five (5) tier cost-sharing structure in 2022. In 2022, Prescription Blue Select plan formulary will change as shown in the chart below.

Michigan Prescription Blue Select (PDP) 2021 and 2022 Medicare Part D plan Cost-sharing Comparison
2021			2022
Monthly Premium		$87.70			$96.20
Initial Deductible		$445			$480
Gap Coverage		No Gap Coverage			No Gap Coverage
Tier	2021 Cost-Sharing			Drugs on Tier	Tier	2022 Cost-Sharing		Drugs on Tier
1	All formulary drugs		25%	122	1	Preferred Generic	$1	83
-	-		-	-	2	Generic	$5	586
-	-		-	-	3	Preferred Brand	$35	863
-	-		-	-	4	Non-Preferred Drug	45%	659
-	-		-	-	5	Specialty Tier	25%	570
Total Formulary Drugs	Browse 2021 Formulary			2,819	Browse 2022 Formulary		2,768

What do the 2021/2022 plan changes mean to you?

Tier 1 preferred generics with a retail cost over $4 will be less expensive in 2022.
Tier 2 generics with a retail cost over $20 will be less expensive.
The cost of Tier 3 preferred brand drugs with a retail cost over $140 will be less expensive than last year - and this tier has the largest number of drugs.
The cost of Tier 4 non-preferred drugs is increasing from 25% to 45% of retail drug costs.
You can also see from the chart that the number of drugs being covered by this plan is decreasing by 51 - and you will need to contact your 2021 plan to ensure that your medications are still covered by the 2022 plan.

Changing the cost-sharing for a formulary tier - In another example, the 2021 California SilverScript Choice (PDP) plan formulary covers 1,061 medications as Tier Three "Preferred Brand" medications (with a $35 copay). In 2022, Tier Three "Preferred Brand" will have a 17% coinsurance.

California SilverScript Choice (PDP) 2021 and 2022 Medicare Part D plan Cost-sharing Comparison
2021			2022
Monthly Premium		$29.50			$30.60
Initial Deductible		$250			$480
Gap Coverage		No Gap Coverage			No Gap Coverage
Tier	2021 Cost-Sharing			Drugs on Tier	Tier	2022 Cost-Sharing		Drugs on Tier
1	Preferred Generic		$0	95	1	Preferred Generic	$0	97
2	Generic		$5	440	2	Generic	$5	599
3	Preferred Brand		$35	1,061	3	Preferred Brand	17%	829
4	Non-Preferred Drug		39%	911	4	Non-Preferred Drug	35%	1,009
5	Specialty Tier		28%	602	5	Specialty Tier	25%	548
Total Formulary Drugs	Browse 2021 Formulary			3,014	Browse 2022 Formulary		3,090

What do the 2021/2022 plan changes mean to you?

The changes from a $47 co-pay to a 17% of retail cost-sharing may mean that you are paying less for your Tier 3 medications in 2022. So, if your Tier 3 drugs have a retail price of under $206, you will save money in 2022 with the new 17% cost-sharing.
You will pay slightly less for your Tier 4 and 5 medications in 2022.

How many people will be affected by these 2021/2022 plan changes?

There are approximately 3,455,120 members in the 2021 SilverScript Choice (PDP) who will see similar changes in their plan coverage.

In total, 3.6 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 2022 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 2022.

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 2022 Medicare Part D or Medicare Advantage plan options.