As a note: The size of a Medicare Part D prescription drug plan formulary is measured in NDCs or National Drug Codes. These 11 digit codes are used by doctors and pharmacies to uniquely identify a medication, the strength, and the packaging. The NDC for your medication appears on the label of your prescription bottle. (Throughout this article, we use the terms drugs, medications and NDCs interchangeably.)
For the 2016 plan year, the largest increase in stand-alone prescription drug plan formulary size is the EnvisionRxPlus Clear Choice plan in South Carolina, Oregon and Washington State (members in other states are being reassigned to the EnvisionRxPlus Silver plan). The 2015 EnvisionRxPlus Clear Choice plan formulary contained 3,212 drugs and the 2016 formulary will contain 3,355 drugs – an addition of 143 medications or NDCs.
However, the vast majority of stand-alone Medicare Part D prescription drug plans will see a reduction of at least 100 medications from their current plan formulary. In fact, based on our analysis, over 10 million Medicare beneficiaries currently enrolled in stand alone Medicare Part D plans that will see at least 100 NDCs removed from their formulary. For example, the Pennsylvania and West Virginia 2016 Blue Rx Complete (PDP) will lose 1,351 drugs as compared to the plan's 2015 formulary.
Changes in the largest 2015 Medicare Part D formularies
Here are several examples of 2015 stand-alone Medicare Part D plans with the largest formularies and how their formularies are changing in 2016. (Again, the formulary size in the chart below is measured in NDCs or National Drug Codes -- used by pharmacies to uniquely identify a medication, the strength, and the packaging).
| 2015 Medicare Part D Plans with the Largest Formularies |
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| Plan Name | 2016 Formulary Size |
2015 Formulary Size | Change in Size |
Members Affected |
| Blue Rx Complete (PDP) | 4,465 | 5,816 | -1,351 | 14,749 |
| Educators Rx Advantage (PDP) | 5,577 | 5,639 | -62 | 560 |
| SecureRx - Option 1 (PDP) | 4,063 | 5,294 | -1,231 | 1,712 |
| First United American - Enhanced (PDP) | sanctioned | 5,294 | tbd | 5,712 |
| United American - Enhanced (PDP) | sanctioned | 5,294 | tbd | 78,525 |
| Blue Rx Plus (PDP) | 4,465 | 4,839 | -374 | 24,472 |
| Symphonix Rite Aid Premier Rx (PDP) | 3,444 | 4,018 | -574 | 1,467 |
| Symphonix Premier Rx (PDP) | 3,444 | 4,018 | -574 | 951 |
| BlueMedicare Rx-Option 1 (PDP) | 3,993 | 3,980 | 13 | 71,930 |
| BlueMedicare Rx-Option 2 (PDP) | 3,993 | 3,980 | 13 | 8,360 |
| AR Blue Cross - Medi-Pak Rx Premier (PDP) | 3,991 | 3,978 | 13 | 11,017 |
| BlueRx Option II (PDP) | 3,991 | 3,978 | 13 | 22,533 |
| AARP MedicareRx Preferred (PDP) | 3,312 | 3,883 | -571 | 3,502,874 |
| Humana Enhanced (PDP) | 3,635 | 3,883 | -248 | 1,147,075 |
The following chart highlights the five stand-alone 2016 Medicare Part D plans with the largest drug formularies and how their formularies have changed since 2014.
| 2016 Medicare Part D Plans with the Largest Formularies |
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| 2016 Plan Name | Formulary Size (NDCs) | ||
| 2016 | 2015 | 2014 | |
| Educators Rx Advantage (PDP) | 5,577 | 5,639 | 5,136 |
| Blue Rx Complete (PDP) | 4,465 | 5,816 | 5,227 |
| Blue Rx Plus (PDP) | 4,465 | 4,839 | 4,342 |
| SecureRx - Option 1 (PDP) | 4,063 | 5,294 | 4,967 |
| BlueMedicare Rx-Option 2 (PDP) | 3,993 | 3,980 | 3,663 |
Although three of the largest 2016 drug plan formularies shown in the table above are offered by "Blue" plans, several of the 2016 Medicare Part D plans with the smallest formularies are also Blue plans.
| 2016 Medicare Part D Plans with the Smallest Formularies |
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| 2016 Plan Name | Formulary Size (NDCs) | ||
| 2016 | 2015 | 2014 | |
| BlueCross Rx Value (PDP) (formerly MedBlue Rx) | 2,492 | 3,194 | 2,839 |
| Blue Medicare Rx Standard (PDP) | 2,492 | 2,523 | 2,244 |
| Blue Cross MedicareRx Basic (PDP) | 2,492 | 2,523 | 2,244 |
| MedicareBlue Rx Standard (PDP) | 2,757 | 2,733 | 2,839 |
| Blue MedicareRx Value (PDP) | 2,792 | 2,871 | 2,463 |
Please remember: A “larger” or “smaller” formulary does not necessarily reflect on the quality of the Medicare plan. Your goal is to find a Medicare plan that offers the most affordable coverage for your 2016 health and prescription needs.
Browsing any Medicare plan’s formulary:
Our Formulary Browser for both stand-alone Medicare Part D plans and Medicare Advantage plans can be found at Formulary-Browser.com/2016. Here, you can browse by letter though each plan’s entire formulary to review cost-sharing and the details of the drug’s utilization management restrictions such as quantity limits, prior authorization, and step therapy. Quantity limits are displayed as Q:30/90days meaning that this drug has a quantity limit of 30 units (such as “tablets”) for a 90 day period.
Comparing drug costs across Medicare plans:
Our Drug Finder is available at on this site. Similar to our Formulary Browser, our Drug Finder displays the cost-sharing and details of the utilization management restrictions, but in the Drug Finder, this information is shown for a particular drug across all plans in your chosen service area. As an example, click here to see the 34 Medicare Advantage plans available in Allegheny County, PA (ZIP: 15228) that cover Atorvastatin 10MG. Once you are on the Drug Finder page, you can change the ZIP code to your ZIP and change the drug to your medication.
For a stand-alone Medicare prescription drug plan example, click here to review the 26 Medicare Part D drug plans available in Pennsylvania that cover Atorvastatin 10MG. Again, change the state to your state once you are on the Drug Finder page.