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Almost 2.5 million Medicare beneficiaries will see at least 100 fewer medications on their 2020 Medicare Part D drug plan formulary

Category: Annual Medicare Plan Changes
Published on 2019-10-16 09:57:59


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.)

First the good news, almost seven million Medicare beneficiaries will see 100 or more drugs (NDCs) added to their plan formulary.  The largest increase in stand-alone prescription drug plan formulary size are the Blue Cross Rx Value and Plus plans in South Carolina with the addition of 454 NDCs bring their formulary size up to 3,414 from 2,960 in 2019. 

However, almost 2.5 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 Aetna Medicare Rx Select and Value Plus plans will loose 349 NDCs from their formulary as they transition to the 2020 WellCare Medicare Rx Select and Value Plus plans.

Changes in the largest 2019 Medicare Part D formularies for 2020
Here are several examples of 2019 stand-alone Medicare Part D plans with the largest formularies and how their formularies are changing in 2020.  (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).

2019 Medicare Part D Plans with the
Largest Formularies and Change for 2020
Plan Name 2020 Formulary Size
2019 Formulary Size Change
in Size
Members Affected
Blue Rx PDP Complete (PDP) and Blue Rx PDP Plus (PDP) 4,265 4,160 105 27,539
AR Blue Cross - Medi-Pak Rx Premier (PDP), Florida BlueMedicare Complete Rx (PDP), and AL TN BlueRx Enhanced Plus (PDP) 4,205 4,088 117 34,470
SecureRx - Option 1 (PDP) 3,341 4,086 -745 1,615
Aetna Medicare Rx Select (PDP) and Aetna Medicare Rx Value Plus (PDP) will become WellCare plans 3,388 3,737 -349 1,185,639
Farm Bureau Essential Rx (PDP) and Farm Bureau Select Rx (PDP) 3,414 3,700 -286 5,034
Asuris Medicare Script Enhanced (PDP) 3,605 3,549 56 1,597
Regence Medicare Script Enhanced (PDP) 3,605 3,549 56 1,169
Blue Cross MedicareRx Plus (PDP) and Blue Cross MedicareRx Value (PDP) 3,487 3,511 -24 188,198
Prescription Blue Preferred (PDP) and Prescription Blue Premium (PDP) 3,335 3,369 -34 28,336
AARP MedicareRx Preferred (PDP) 3,500 3,367 133 2,218,706
Blue Shield Rx Enhanced (PDP) 3,363 3,356 7 32,103

Although many of the largest 2019 drug plan formularies shown in the table above are offered by "Blue" plans, several of the 2020 Medicare Part D plans with the smallest formularies are also Blue plans.

2020 Medicare Part D Plans with the
Smallest Formularies
Plan Name 2020 Formulary Size
2019 Formulary Size Change
in Size
Members Affected
Asuris Medicare Script Basic (PDP) 2,665 2,591 74 3,659
Blue Medicare Rx Standard (PDP), BlueMedicare Premier Rx (PDP), BlueRx Essential (PDP), Horizon Medicare Blue Rx Standard (PDP), and Regence Medicare Script Basic (PDP) 2,665 2,591 74 88,941
SecureRx - Option 3 (PDP) 2,665 3,078 -413 1,997
Blue Cross MedicareRx Basic (PDP) 2,724 3,056 -332 88,769
Prescription Blue Select (PDP) 2,814 2,795 19 9,249
Anthem Blue Cross MediBlue Rx Standard (PDP), Anthem MediBlue Rx Standard (PDP), and Blue MedicareRx Value (PDP) 2,847 2,795 52 126,164
Express Scripts Medicare - Saver (PDP) 2,892 2,806 86 214,812
Mutual of Omaha Rx Value (PDP) 2,892 2,806 86 36,540

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 2020 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/2020. 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 29 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 2020 Medicare Part D and Medicare Advantage plans that most affordably meet their health and prescription needs.






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