Changes in 2012 Medication Co-payments or Cost-Sharing Designs

As in past years, some 2011 Medicare Part D plans are changing cost-sharing or co-payment rates for covered prescription drug purchases. For example, the 2011 CVS Caremark Plus Plan has changed the definition of their drug tiers, combining preferred and non-preferred generics into Tier 1 with a $0 co-pay. The monthly premium for New York state residents (shown in the chart below) has increased by $14.70 and the plan no longer offers Donut Hole or Gap Coverage. To browse the New York CVS Caremark Plus plan formulary online, you can click here for our Formulary Browser.

New York CVS Caremark Plus Plan
2011	2012
Monthly Premium	$55.50	$70.20
Initial Deductible	$0	$0
Gap Coverage	Many Generics	No Gap Coverage
Tier 1 Cost-Sharing	Preferred Generics: $2	Generic Drugs: $0
Tier 2 Cost-Sharing	Non-Preferred Generics: $5	Preferred Brand Drugs: $40
Tier 3 Cost-Sharing	Preferred Brand Drugs: $35	Non-Preferred Brand Drugs: $90
Tier 4 Cost-Sharing	Non-Preferred Brand and Non-Preferred Generics: $90	Specialty Drugs: 33%
Tier 5 Cost-Sharing	Specialty Drugs: 33%

The AARP plans did the exact opposite of the CVS Caremark Plus plan and added in a new drug cost-sharing tier in both their Preferred and Enhanced plans. Namely, in their Preferred plan adding a low cost preferred generic drug tier and in their Enhanced plan adding a non-preferred generic drug tier with a slightly higher co-pay than the preferred generic drug tier (see chart below for Florida AARP MedicareRx Preferred Plan changes). The AARP plans have also dropped about 70 drug/strength/packaging combinations (NDCs) from their formularies. To browse the Florida AARP MedicareRx Preferred plan formulary online, you can click here for our Formulary Browser.

Florida AARP MedicareRx Preferred Plan
2011	2012
Monthly Premium	$35.80	$40.00
Initial Deductible	$0	$0
Gap Coverage	No Gap Coverage	No Gap Coverage
Tier 1 Cost-Sharing	Preferred Generic Brand: $8	Preferred Generic Drugs: $4
Tier 2 Cost-Sharing	Generic Preferred Brand: $42	Non-Preferred Generic Drugs: $8
Tier 3 Cost-Sharing	Non-Preferred Generic Non-Preferred Brand: $80	Preferred Brand Drugs: $41
Tier 4 Cost-Sharing	Specialty Drugs: 33%	Non-Preferred Brand Drugs: $95
Tier 5 Cost-Sharing	Specialty Tier Drugs: 33%

Here are a few additional examples of other cost-sharing changes related just to Tier 3 drugs (the actual cost-sharing could vary state-to-state).

2011 Tier 3 Cost-Sharing	2012 Tier 3 Cost-Sharing
CIGNA Rx Plan One in California	$75	$35
AARP MedicareRx Preferred in New York	$82	$42
Community CCRx Basic in PA and WV	25%	$95