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2019 Medicare Drug Plan Analysis: Over 11 million Medicare beneficiaries will see at least 100 fewer medications on their 2019 Medicare Part D drug plan formulary


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2019 Medicare Drug Plan Analysis: Over 11 million Medicare beneficiaries will see at least 100 fewer medications on their 2019 Medicare Part D drug plan formulary
Published on 2018-10-19 19:08:48
Category: Annual Medicare Plan Changes


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, NM, OK, and TX, 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
Plan Name 2019 Formulary Size
2018 Formulary Size Change
in Size
Members Affected
Educators Rx Advantage (PDP) discontinued in 2019 -- 5,900
-- 542
First Health Part D Value Plus (PDP) name-change to the Aetna Medicare Rx Value Plus (PDP) 3,737 5,257 or 3,924 depending on state -1,520 to -187 558,633
First Health Part D Premier Plus (PDP) crosswalked to the Aetna Medicare Rx Value Plus (PDP) 3,737 5,256 -1,519 17,220
Aetna Medicare Rx Select (PDP) 3,737 5,218 -1,481 326,489
Blue Rx PDP Complete (PDP) & Blue Rx PDP Plus (PDP) 4,160 4,357 -197 30,047
SecureRx - Option 1 (PDP) 4,086 4,198 -112 1,469
BlueMedicare Complete Rx (PDP)BlueMedicare Complete Rx (PDP) 4,088 4,191 -103 27,782
Farm Bureau Essential Rx (PDP) & Farm Bureau Select Rx (PDP) 3,700 3,821 -121 6,110

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
Smallest Formularies
Plan Name 2019 Formulary Size
2018 Formulary Size Change
in Size
Members Affected
Blue Medicare Rx Standard (PDP) & Horizon Medicare Blue Rx Standard (PDP) 2,591 2,667 -76 18,223
BlueMedicare Premier Rx (PDP) & BlueRx Option I (PDP) 2,591 3,301 -710 81,999
Asuris Medicare Script Basic (PDP) & Regence Medicare Script Basic (PDP) 2,591 3,685 -1,094 6,954
Blue MedicareRx Standard (PDP) & Blue MedicareRx Value (PDP) 2,795 2,967 -172 89,410
Prescription Blue Option A (PDP) 2,795 3,664 -869 8,287
Mutual of Omaha Rx Value (PDP) 2,806 new new new

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 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 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 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.


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