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Drug List Updates: New Generics Don't Always Mean Big Savings.

Category: Monthly Formulary Changes
Published on 2018-04-30 15:20:06

As you may know, Medicare Part D prescription drug plans are allowed to update their plan formularies or drug lists throughout the plan year and the April 2018 Medicare Part D formulary updates included 486 new drugs, including 57 new generic drugs - with 103 new generic equivalents (variations of manufacturer, drug-strength, and packaging).

When your Medicare drug plan adds a new generic, you may find that you can save money by switching from your brand-name drug to the newly-added generic equivalent – with your prescriber’s approval and a new prescription.

However, switching to a generic does not always guarantee a large savings.  Medicare plan members need to look carefully at their Medicare plan’s coverage as some new 2018 generics are being offered on the same cost-sharing formulary tier as their brand-name equivalent and/or the new generics do not have a significantly lower retail price.

For example, the brand-name drug Emend 40 MG has a retail cost of around $125 and, as a Tier 4 drug, has cost-sharing of 45% co-insurance. The same Medicare drug plan may cover the generic equivalent APREPITANT 40 MG, also as a Tier 4 drug (45% co-insurance) with an approximate retail cost of $88.

So you would pay approximately $56 for the brand-name drug Emend or $40 for the generic-equivalent drug Aprepitant - and people will need to decide whether the $16 savings is worth changing from a brand to a generic.

As noted above, you will need to check your Medicare plan's coverage details to learn more about what you would pay for the generic of brand-name drug.  Looking closer at our example, the brand-name drug, Emend 40 MG is covered on only seven (7) Medicare Part D plans in Florida and has a retail price ranging from $117.37 to $124.80 – with plan cost-sharing from $18 to $93.

In comparison, 21 stand-alone Medicare Part D plans in Florida cover the generic Aprepitant 40 MG, with cost-sharing from a $10 to $42 co-pay or co-insurance anywhere from 18% to 50% of retail.  This means your cost-sharing for this generic drug could range from a $10 co-pay to $44 co-insurance, depending on your chosen Medicare Part D plan.

So in this specific example of Florida plans, you could pay anywhere from $18 to $93 for the brand drug or $10 to $44 for the generic.  To learn more, you can click here to see how your Medicare drug plan is covering these medications.

As a note, both our Formulary Browser (you can view all the drugs covered by a single Medicare prescription drug plan) and our Q1Rx Drug Finder (you can view all the Medicare drug plans covering a single drug) have been updated with the April 2018 Medicare Part D formulary data.

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