As many people know, Medicare Part D prescription drug plans (
PDPs and MAPDs) can update their plan formularies or drug lists throughout the plan
year. These updates can include dropping drugs, moving drugs to a different drug tier, and adding new brand-name and generic drugs.
For example, the
April 2018
Medicare Part D formulary updates included
737 new drug codes or NDCs representing 486 different medications, with
103 being new generic equivalents
(variations of manufacturer, drug-strength, and packaging).
New Generics Replacing Existing Brand-Name Drugs During the Plan Year
Over the months following the introduction of new generics, Medicare Part D plan members may find that their brand-name drug is no longer covered by their Medicare plan - and is instead being replaced with one of the new generics.
What to do when there is a mid-year formulary change and your brand-name drug is no longer covered
(1) If your brand-name drug is no longer covered, you can work with your prescriber to find an alternative medication on your plan’s formulary. To assist with your search, you can use our
Formulary Browser to see all medications covered by your Medicare plan.
(2) You can try the
generic equivalent and see whether the generic medication works the same
for you. Some people may find that they are not able to use a generic
equivalent because of variations in the drug’s “inactive” ingredients.
If the generic is produced by multiple manufacturers, you may want to
evaluate the various generics to determine which one is most similar
to the brand, e.g. uses the same inactive ingredients.
(3) You can ask your Medicare Part D plan to grant a
formulary exception to continue coverage of your brand-name drug – you will need to
work with your doctor or prescriber to explain why the generic medication will not work. If your formulary exception is denied, you have the
right to appeal your plan’s decision. You can
click to read more about mid-year formulary changes in our Frequently Asked Questions.
The introduction of new generics now may affect your Medicare plan coverage next year
So even if your Medicare drug plan does drop an existing brand-name drug
when a newly-available generic is introduced, you may find that the
introduction of new generic drugs this year means your Medicare plan may
not cover your brand-name drug next year.
For example, a number of new generics were introduced in Spring 2017 and
their brand-name equivalents were removed from
the plan formulary at the end of the 2017 plan year, meaning the
brand-name drugs were no longer covered by the Medicare Part D plan in
2018.
We evaluated four (4) drugs, some with multiple strengths (12 National Drug Codes (NDCs) in total):
Each of these brand-name drugs had been covered on at least 52 of the 59 available 2017
Medicare PDP formularies. However, since the start of the 2018 plan year, only a handful of Medicare Part D plan still
cover all 12 variations of theses brand-name drugs.
For example, the following six 2018 Medicare plans continue to cover all 12 drugs:
And not surprisingly, these six stand-alone 2018 Medicare Part D plans also have some of the largest PDP formularies available.
For more information, you can
click here to see a chart of trends in
formulary coverage for some of the more popular Medicare drugs and their generic equivalents.
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.