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.