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.)
The largest increase
in stand-alone prescription drug plan
formulary size are the Blue MedicareRx Essential plan in Arizona
with the addition of 445 NDCs bring their formulary size up to 3,115 from 3,560 in 2021.
However, over 2 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 AR Blue Cross - Medi-Pak Rx Basic (PDP)
will lose 715 NDCs from their formulary.
Changes in the largest 2020 Medicare Part D formularies for 2021
Here are several examples of 2020 stand-alone Medicare Part
D plans with the largest formularies and how their formularies are changing in
2021. (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).
|2020 Medicare Part D Plans with the
Largest Formularies and Change for 2021
||2021 Formulary Size
|2020 Formulary Size
|Blue Rx PDP Complete (PDP) and Blue Rx PDP Plus (PDP)
|AR Blue Cross - Medi-Pak Rx Premier (PDP), Florida BlueMedicare Complete Rx (PDP), and AL TN BlueRx Enhanced Plus (PDP)
|ID UT Regence Medicare Script Enhanced (PDP) and OR WA Asuris Medicare Script Enhanced (PDP)
|Blue Cross MedicareRx Value (PDP) and Blue Cross MedicareRx Plus (PDP)
|AARP MedicareRx Preferred (PDP)
|SC Blue Cross MedicareRx Plus (PDP) and SC Blue Cross MedicareRx Value (PDP)
|AL TN Farm Bureau Essential Rx (PDP) and AL TN Farm Bureau Select Rx (PDP)
|WellCare Medicare Rx Select (PDP)
|WellCare Medicare Rx Value Plus (PDP)
Although many of the largest 2020 drug plan formularies shown in the table above are offered by "Blue" plans, several of the 2021 Medicare Part D plans with the smallest formularies are also Blue plans.
|2021 Medicare Part D Plans with the
||2021 Formulary Size
|2020 Formulary Size
|AR BlueMedicare Value Rx (PDP)
|NC Blue Medicare Rx Standard (PDP)
|OR WA Asuris Medicare Script Basic (PDP),
AL TN BlueRx Essential (PDP),
FL BlueMedicare Premier Rx (PDP),
ID UT Regence Medicare Script Basic (PDP) and PA WV SecureRx - Option 3 (PDP),
|Blue Cross MedicareRx Basic (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 2021 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/2021
. 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 36 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 28 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 2021 Medicare
Part D and Medicare Advantage plans that most affordably meet their health and prescription needs.