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Annual Medicare drug plan changes: Examples of how 2021 Medicare Part D plans change formulary cost-sharing.

Category: Annual Medicare Plan Changes
Published on 2020-10-03 17:05:27


As in past years, some 2020 Medicare Part D plans are changing their cost-sharing designs for 2021 prescription drug purchases.  Cost-sharing is what you will pay for your Medicare Part D formulary drugs and can be either a fixed-copay (Tier 3 drugs are a $47 co-pay) or cost-sharing can be a percentage of the drug's retail cost (25% of retail).  Each year, Medicare drug plans can also change the structure of the plan's formulary or drug list and add - or take away - formulary tiers - or the plan can move drugs from one Tier to another.

Adding new formulary drug tier - For example, the Express Scripts Medicare - Value  and Choice plans will add one drug tier to their formulary in 2021.  In the 2020 Express Scripts Medicare - Value plan formulary had five (5) drug tiers (as shown in the chart below).

In comparison, the 2021 Express Scripts Medicare - Value plan formulary has added a new 6th drug tier for Select Care Drugs -- with a $0 copay.

New York Express Scripts Medicare - Value (PDP)
2020 and 2021 Medicare Part D plan Cost-sharing Comparison
  2020 2021
Monthly Premium $35.50 $33.20
Initial Deductible $435 $445
Gap Coverage No Gap Coverage No Gap Coverage


Tier

2020
Cost-Sharing
Drugs
on Tier


Tier

2021
Cost-Sharing
Drugs
on Tier
1 Preferred Generic $1 122
1 Preferred Generic $1 65
2 Generic $3
707
2 Generic $3 654
3 Preferred Brand $25 679
3 Preferred Brand $20 637
4 Non-Preferred Drug 35% 1,039
4 Non-Preferred Drug 46% 1,075
5 Specialty Tier 25% 506 5 Specialty Tier 25% 475
- - - - 6 Select Care Drugs $0 95
Total Formulary Drugs
Browse 2020 Formulary 3,053   Browse 2021
Formulary
3,001

What do the 2020/2021 plan changes mean to you?
  • The 2021 Medicare Part D plan will have a lower premium as compared to the same 2020 plan, maybe making up for the higher deductible.
  • The cost of Tier 4 drugs is increasing from 35% to 46% of retail drug costs - and this tier has the largest number of drugs.
  • You can also see from the chart that the number of drugs being covered by this plan is decreasing by 52 - and you will need to contact your 2020 plan to ensure that your medications are still covered by the 2021 plan.
  • You can also see that fewer medications are included in low-cost ($1 or $3 co-pay) tiers - this could mean that a low-cost drug may be moving to a more-expensive formulary tier.
  • The addition of a Tier 6 drugs with a $0 co-pay is a positive if you are using any of the 95 drugs on Tier 6.


Changing the cost-sharing for a formulary tier -  In another example, the 2020 California Humana Walmart Value Rx Plan (PDP) plan formulary covers 746 medications as Tier Three "Preferred Brand" medications (with a $47 copay).   In 2021, Tier Three "Preferred Brand" will have a 17% coinsurance.

California Humana Walmart Value Rx Plan (PDP)
2020 and 2021 Medicare Part D plan Cost-sharing Comparison
  2020 2021
Monthly Premium $13.20 $17.20
Initial Deductible $435 $445
Gap Coverage No Gap Coverage No Gap Coverage


Tier

2020
Cost-Sharing
Drugs
on Tier


Tier

2021
Cost-Sharing
Drugs
on Tier
1 Preferred Generic $1 165 1 Preferred Generic $1 150
2 Generic $4 660 2 Generic $4 678
3 Preferred Brand $47 746 3 Preferred Brand 17% 720
4 Non-Preferred Drug 35% 1,016 4 Non-Preferred Drug 35%
1,058
5 Specialty Tier 25% 599 5 Specialty Tier 25% 554
Total Formulary Drugs
Browse 2020 Formulary 3,186   Browse 2021
Formulary
3,160

What do the 2020/2021 plan changes mean to you?
  •  The changes from a $47 co-pay to a 17% of retail cost-sharing may mean that you are paying less for your Tier 3medications in 2021.
  •  Specifically if your Tier 3 drugs have a retail price of under $276, you will save money with the new 2021 17% cost-sharing .
How many people will be affected by these 2020/2021 plan changes?

There are approximately 887,620 members in the 2020 Humana Walmart Value Rx Plan (PDP) who will see similar changes in their plan coverage, if they do not select a new plan during AEP.

As another example of changing cost-sharing, the 705,960 members of the EnvisionRxPlus (PDP) will see their cost-sharing Tier 3 Preferred Brands change from a $35 copay to an 15% co-insurance as their Part D plan becomes the Elixir RxSecure (PDP) in 2021 (in this example, if your Tier 3 retail drug cost is under $233, you will save money with the 15% cos-insurance.

In total, 1.6 million members of various stand-alone Medicare Part D plans will see one or more of the drug tiers change cost-sharing from either coinsurance (such as 15%) to copay (such as $35) or copay to coinsurance.

To compare annual changes in Medicare plans, our PDP-Compare and MA-Compare tools show the 2021 stand-alone Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MAs or MAPDs) across the country and include changes in plan features such as premium, deductible, cost-sharing and formulary size changes. Our compare tools also highlight plans that will be merged or discontinued and new plans being added in 2021.

Not sure where to begin with choosing your Medicare Part D plan?

Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak with a Medicare representative, and learn more about their 2021 Medicare Part D or Medicare Advantage plan options.






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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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