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Annual Medicare drug plan changes: Examples of how 2022 Medicare Part D plans change formulary cost-sharing.

Category: Annual Medicare Plan Changes
Published on 2021-10-16 13:09:09


As in past years, some 2021 Medicare Part D plans are changing their cost-sharing designs for 2022 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 Prescription Blue Select plan will change from a single drug tier for all formulary drugs to a five (5) tier cost-sharing structure in 2022.  In 2022, Prescription Blue Select plan formulary will change as shown in the chart below.

Michigan Prescription Blue Select (PDP)
2021 and 2022 Medicare Part D plan Cost-sharing Comparison
  2021 2022
Monthly Premium $87.70 $96.20
Initial Deductible $445 $480
Gap Coverage No Gap Coverage No Gap Coverage


Tier

2021
Cost-Sharing
Drugs
on Tier


Tier

2022
Cost-Sharing
Drugs
on Tier
1 All formulary drugs 25% 122 1 Preferred Generic $1 83
- - - - 2 Generic $5 586
- - - - 3 Preferred Brand $35 863
- - - - 4 Non-Preferred Drug 45% 659
- - - - 5 Specialty Tier 25% 570
Total Formulary Drugs
Browse 2021
Formulary
2,819   Browse 2022
Formulary
2,768


What do the 2021/2022 plan changes mean to you?
  • Tier 1 preferred generics with a retail cost over $4 will be less expensive in 2022.
  • Tier 2 generics with a retail cost over $20 will be less expensive.
  • The cost of Tier 3 preferred brand drugs with a retail cost over $140 will be less expensive than last year - and this tier has the largest number of drugs.
  • The cost of Tier 4 non-preferred drugs is increasing from 25% to 45% of retail drug costs.
  • You can also see from the chart that the number of drugs being covered by this plan is decreasing by 51 - and you will need to contact your 2021 plan to ensure that your medications are still covered by the 2022 plan.


Changing the cost-sharing for a formulary tier - In another example, the 2021 California SilverScript Choice (PDP) plan formulary covers 1,061 medications as Tier Three "Preferred Brand" medications (with a $35 copay).   In 2022, Tier Three "Preferred Brand" will have a 17% coinsurance.

California SilverScript Choice (PDP)
2021 and 2022 Medicare Part D plan Cost-sharing Comparison
  2021 2022
Monthly Premium $29.50 $30.60
Initial Deductible $250 $480
Gap Coverage No Gap Coverage No Gap Coverage


Tier

2021
Cost-Sharing
Drugs
on Tier


Tier

2022
Cost-Sharing
Drugs
on Tier
1 Preferred Generic $0 95 1 Preferred Generic $0 97
2 Generic $5 440 2 Generic $5 599
3 Preferred Brand $35 1,061 3 Preferred Brand 17% 829
4 Non-Preferred Drug 39% 911 4 Non-Preferred Drug 35% 1,009
5 Specialty Tier 28% 602 5 Specialty Tier 25% 548
Total Formulary Drugs
Browse 2021
Formulary
3,014   Browse 2022
Formulary
3,090


What do the 2021/2022 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 3 medications in 2022. So, if your Tier 3 drugs have a retail price of under $206, you will save money in 2022 with the new 17% cost-sharing.
  • You will pay slightly less for your Tier 4 and 5 medications in 2022.
How many people will be affected by these 2021/2022 plan changes?

There are approximately 3,455,120 members in the 2021 SilverScript Choice (PDP) who will see similar changes in their plan coverage.

In total, 3.6 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 2022 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 2022.

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 2022 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.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
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