Q1Group 2016 Drug Plan Analysis: Example of how 2016 Medicare Part D plans can change prescription co-payments or cost-sharing designs

As in past years, some 2015 Medicare Part D plans are changing their cost-sharing structures for 2016 prescription drug purchases. For example, the SilverScript Choice plan will add a "Preferred Generic" tier as Tier One and the former "Generic" tier will become Tier Two in 2016.

As can be seen in the following example, the 2015 SilverScript Choice plan formulary covers 671 medications as Tier One "Generic" medications (with an $8 co-pay). In comparison, the 2016 SilverScript Choice plan formulary covers 102 medications as Tier One "Preferred Generics" (with an $3 co-pay) and 444 drugs as Tier Two "Generics" (with an $17 co-pay).

California SilverScript Choice 2015 and 2016 Medicare Part D plan Cost-sharing Comparison
2015			2016
Monthly Premium		$22.20			$23.10
Initial Deductible		$0			$0
Gap Coverage		No Gap Coverage			No Gap Coverage
Tier	2015 Cost-Sharing			Drugs on Tier	Tier	2016 Cost-Sharing		Drugs on Tier
--	--		1	Preferred Generic	$3	102
1	Generic		$8	671	2	Generic	$17	444
2	Preferred Brand		$41	1,071	2	Preferred Brand	$46	924
3	Non-Preferred Brand		43%	902	3	Non-Preferred Brand	47%	1,076
4	Specialty Tier		33%	399	4	Specialty Tier	33%	425
Total Formulary Drugs	Browse 2015 Formulary			3,043	Browse 2016 Formulary		2,971

There are approximately 3,298,354 members in the 2015 SilverScript Choice plan and an additional 124,563 members in the SilverScript Plus plan that will see a similar change in their cost-sharing structure.

If you would like to learn how the Generics were sorted between the 2016 Generic and Preferred Generic tiers, you can click here to browser the California SilverScript Choice 2016 Formulary.

To compare annual changes in Medicare plans, our PDP-Compare and MA-Compare tools show the 2015 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 2016.