With each new plan year - and throughout the plan year - your Medicare Part D plan (PDP) or Medicare Advantage plan
that provides prescription coverage (MAPD) can change their formulary or drug list,
introducing or removing medications.
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 2019 plan year, the largest increase
in stand-alone prescription drug plan
formulary size is the Blue Cross MedicareRx Basic plan in IL
, with the addition of 428 NDCs bring the formulary size up to 3,056 from 2,628 in 2018.
However, about 11 million members of stand-alone Medicare Part D prescription drug plans will see
a reduction of at least 100 medications from their current plan formulary. For example, the First Health Part D Value Plus (PDP)
will loose 1,520 NDCs from their formulary as they are transitioned to the 2019 Aetna Medicare Rx Value Plus (PDP).
Changes in the largest 2018 Medicare Part D formularies
Here are several examples of 2018 stand-alone Medicare Part
D plans with the largest formularies and how their formularies are changing in
2019. (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).
|2018 Medicare Part D Plans with the
Largest Formularies and Change for 2019
||2019 Formulary Size
|2018 Formulary Size
|Educators Rx Advantage (PDP) discontinued in 2019
|First Health Part D Value Plus (PDP) name-change to the Aetna Medicare Rx Value Plus (PDP)
||5,257 or 3,924 depending on state
||-1,520 to -187
|First Health Part D Premier Plus (PDP) crosswalked to the Aetna Medicare Rx Value Plus (PDP)
|Aetna Medicare Rx Select (PDP)
|Blue Rx PDP Complete (PDP) & Blue Rx PDP Plus (PDP)
|SecureRx - Option 1 (PDP)
|BlueMedicare Complete Rx (PDP)BlueMedicare Complete Rx (PDP)
|Farm Bureau Essential Rx (PDP) & Farm Bureau Select Rx (PDP)
Although many of the largest 2018 drug plan formularies shown in the table above are offered by "Blue" plans, several of the 2019 Medicare Part D plans with the smallest formularies are also Blue plans.
|2019 Medicare Part D Plans with the
||2019 Formulary Size
|2018 Formulary Size
|Blue Medicare Rx Standard (PDP) & Horizon Medicare Blue Rx Standard (PDP)
|BlueMedicare Premier Rx (PDP) & BlueRx Option I (PDP)
|Asuris Medicare Script Basic (PDP) & Regence Medicare Script Basic (PDP)
|Blue MedicareRx Standard (PDP) & Blue MedicareRx Value (PDP)
|Prescription Blue Option A (PDP)
|Mutual of Omaha Rx Value (PDP)
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 2019 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 (MAPDs
) can be found at Formulary-Browser.com
. Using the Formulary Browser, 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 drugs 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 Q1Rx.com/2018
. 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 37 Medicare Advantage plans available in Allegheny County, PA
(ZIP: 15228) that cover Advair Diskus MIS 250/50
. Once you are on the Drug Finder
page, you can change the ZIP code to your ZIP and change the drug to your
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
Advair Diskus MIS 250/50
. Again, change the
state to your state once you are on the Drug Finder page.
Need help finding the Medicare plan with the most affordable coverage?
Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak
with a Medicare representative, and learn more about 2019 Medicare
Part D and Medicare Advantage plans that most affordably meet their health and prescription needs.