There can be a number of reasons for why you are now finding that your new Medicare Part D plan is costing your more than last year - even though you did not change Medicare plans.
1. The simplest is that with the start of the new plan year on January 1st, your plan coverage starts over and if your plan has a deductible, you are in it. You will go into the cost-sharing phase of your coverage once you reach your deductible.
2. Your plan has added a deductible (this only happened on a handful of plans in 2012)
3. Your plan has changed its drug tier structure on its formulary (or drug list)
4. Your plan has moved drugs to a higher tier on its formulary (or drug list)
5. Your plan has dropped your drug from its formulary (or drug list)
6. Your plan has different pricing for preferred network pharmacies vs. non-preferred network pharmacies and you purchased your medication at a non-preferred network pharmacy in January (either you switched pharmacies or your plan just started using different pricing for preferred vs. non-preferred network and your pharmacy happens to be a non-preferred network pharmacy)
Here is one particular example:
I have the same Medicare Advantage plan (SummaCare Secure Gold (HMO-POS) in Summit, OH) as last year and a refill of FENOFIBRATE 200MG that cost me $4 in December, 2011 now cost me $8 in January, 2012. Why am I paying more?
You probably will find several different reasons for why you are paying more. First, the reason you see a jump in your co-payment for FENOFIBRATE 200MG is because your plan changed it’s formulary (or drug list) structure between the 2011 plan year and 2012. In 2011, your plan formulary used four (4) drug tiers. In 2012, they split the 2011 Tier 1 (generics) into two (2) tiers: Tier 1 is now preferred generics and Tier 2 is non-preferred generics.
| 2011 | 2012 |
| Tier 1: Generic Drugs: $4.00 | Tier 1: Preferred Generic Drugs: $0.00 |
| Tier 2: Non-Preferred Generic Drugs: $8.00 | |
| Tier 2: Preferred Brand Drugs: $40.00 | Tier 3: Preferred Brand Drugs: $45.00 |
| Tier 3: Non-Preferred Brand Drugs: $80.00 | Tier 4: Non-Preferred Brand Drugs: $85.00 |
| Tier 4: Specialty Tier Drugs: 33% | Tier 5: Specialty Tier Drugs: 33% |
Although the changes to the structure of your drug tiers is outlined in the Annual Notice of Change (ANOC) letter that you receive from your insurance carrier in late September, the document is sometimes overlooked because it is often combined with the Evidence of Coverage document and together they total about 200 pages. The first 17-20 pages are the ANOC and the remaining pages are the Evidence of Coverage. We highly recommend reviewing your ANOC each year when it arrives.
Another way to compare the changes in your plan is to take a look at our overview for your 2011 plan (MA-Finder.com/2011)
And compare it to our 2012 plan overview (MA-Finder.com/2012)
Using these tools, you can see that your cost-sharing has changed as noted in the chart above.
Your Annual Notice of Change letter will not tell you if your medication has changed drug tiers. To review drug tier changes, you will need to review your plan’s formulary (also known as their Drug List). Our MA-Finder tools (links above) have a link that goes directly to the plan’s online formulary.
In the 2011 SummaCare Secure Gold formulary, we can see that FENOFIBRATE 200MG was a tier one drug in 2011, with a $4 co-pay.
(If you click on the “Browse Formulary” link from the 2012 MA-Finder and scroll down to FENOFIBRATE 200MG you will see that it is a tier two drug with a $8 co-pay. (
Now we can see why you are paying $8 for FENOFIBRATE 200MG rather than $4 as you did in 2011. When SummaCare split their 2011 Tier One into two tiers, FENOFIBRATE 200MG was placed in Tier 2 rather than Tier 1.