Very few Medicare Part D plans keep their cost-sharing structure (co-payments and/or co-insurance) the same from year to year.  In theory, cost-sharing can increase or decrease year-to-year, but in general, the portion you pay for your prescription drugs has a tendency to rise.  And each year, some prescription drug plans have increased their cost-sharing more than others.

For example, the 2017 Cigna-HealthSpring Rx Secure-Extra (PDP) plan:

• increased the co-payments for Tier 1 ($4 increase) and Tier 2 ($5 increase) generic drugs;
• changed Tier 3 preferred brands from co-insurance (20%) to co-payment ($42);
• increased the co-insurance on Tier 4 non-preferred brands to 50% in all states; and
• increased the co-insurance on Tier 5 Specialty drugs. 

The following example applies to all states, except in CT, GA, MA, NV, RI, and VT where the Tier 4 increase is 72% (from cost-sharing of 29% to cost-sharing of 50%).


So how does this example actually affect what people pay for their medications?

• Tier 1 preferred generic drug purchases that were $1 in 2016 will now cost members $5 at the pharmacy.
  
• Tier 2 generics that cost $5 in 2016 will cost $10 in 2017.
  
• Tier 3 preferred brand-name drugs that have a retail price less than $210 will cost more in 2017 -- using the $42 co-pay as compared to the 20% co-insurance from 2016.
  For example: a $120 Tier 3 prescription will cost $42 in 2017 rather than $24 in 2016.  However, Tier 3 prescriptions with a retail price over $210 will cost less in 2017.
  A $300 prescription will only cost $42 in 2017 rather than $60 using the 20% co-insurance from 2016.
• Tier 4 non-preferred brand-name drugs will increase to 50% co-insurance in all states.  This is a 16% increase in most states.  However, as noted above, it is a 72% increase for members in CT, GA, MA, NV, RI, and VT who were paying 29% for Tier 4 medications in 2016.
  
• Tier 5 specialty medications will cost 19% more than they did in 2016 (from co-insurance of 27% to 32% in 2017).
  

How to see changes in annual cost-sharing structure?
To compare annual changes in Medicare plans, our PDP-Compare shows changes in the 2016 stand-alone Medicare Part D prescription drug plans (PDPs) for 2017 and our MA-Compare shows changes in the 2016 Medicare Advantage plans (MAs or MAPDs) for 2017.  Both tools 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, discontinued, or added in 2017.