Q1Group 2019 Drug Plan Analysis: Examples of how 2019 Medicare Part D plans can change prescription cost-sharing designs

As in past years, some 2018 Medicare Part D plans are changing their cost-sharing designs for 2019 prescription drug purchases. For example, the Cigna-HealthSpring Rx Secure-Extra (PDP) will add an additional drug tier to its formulary and the EnvisionRxPlus (PDP) plan in California will change their Tier 3 drugs from a copay of $29 to co-insurance of 15% in 2019.

In the following example, the 2018 Cigna-HealthSpring Rx Secure-Extra plan formulary had five (5) drug tiers. In comparison, the 2019 Cigna-HealthSpring Rx Secure-Extra plan formulary has added a new 6th drug tier for Select Care Drugs--with a $6 copay.

Florida Cigna-HealthSpring Rx Secure-Extra 2018 and 2019 Medicare Part D plan Cost-sharing Comparison
2018			2019
Monthly Premium		$56.70			$61.00
Initial Deductible		$0			$100 (tier 1, 2, 3 and 6 excluded)
Gap Coverage		No Gap Coverage			Some Gap Coverage
Tier	2018 Cost-Sharing			Drugs on Tier	Tier	2019 Cost-Sharing		Drugs on Tier
1	Preferred Generic		$4	242	1	Preferred Generic	$4	205
2	Generic		$10	1,223	2	Generic	$10	841
3	Preferred Brand		$42	582	3	Preferred Brand	$42	391
4	Non-Preferred Drug		50%	982	4	Non-Preferred Drug	50%	1,359
5	Specialty Tier		33%	635	5	Specialty Tier	31%	498
--	--		--	--	6	Select Care Drugs	$6	23
Total Formulary Drugs	Browse 2018 Formulary			3,664	Browse 2019 Formulary		3,317

In the next example, the 2018 California EnvisionRxPlus plan formulary covers 471 medications as Tier Three "Preferred Brand" medications (with a 15% co-insurance). In comparison, the 2019 EnvisionRxPlus plan formulary covers 470 medications as Tier Three "Preferred Brand" with a $29 copay.

California EnvisionRxPlus 2018 and 2019 Medicare Part D plan Cost-sharing Comparison
2018			2019
Monthly Premium		$50.00			$12.90
Initial Deductible		$405			$315
Gap Coverage		No Gap Coverage			No Gap Coverage
Tier	2018 Cost-Sharing			Drugs on Tier	Tier	2019 Cost-Sharing		Drugs on Tier
1	Preferred Generic		$1	139	1	Preferred Generic	$1	142
2	Generic		$3	577	2	Generic	$6	631
3	Preferred Brand		15%	471	3	Preferred Brand	$29	470
4	Non-Preferred Drug		35%	1,460	4	Non-Preferred Drug	37%	1,247
5	Specialty Tier		25%	585	5	Specialty Tier	26%	473
Total Formulary Drugs	Browse 2018 Formulary			3,015	Browse 2019 Formulary		2,963

There are approximately 7,640 members in the 2018 EnvisionRxPlus plan who will see this change. The 25,021 members of the AR Blue Cross - Medi-Pak Rx Basic (PDP) will see their cost-sharing Tier 4 Brands change to a 45% co-insurance.

In total, 32,661 members of various stand-alone Medicare Part D plans will see one or more of the drug tiers change cost-sharing from either coinsurance to copay or copay to coinsurance.

To compare annual changes in Medicare plans, our PDP-Compare and MA-Compare tools show the 2018 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 2019.

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 2019 Medicare Part D or Medicare Advantage plan options.