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.)

For the 2018 plan year, the largest increase in stand-alone prescription drug plan formulary size is the Educators Rx Advantage plan in Idaho and Utah with 5,900 NDCs.  The 2017 Educators Rx Advantage plan formulary contained 5,806 NDCs.

However, about 6 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 Florida BlueMedicare Rx-Option 1 (PDP) will lose 811 NDCs from its formulary as it changes plan names to the 2018 BlueMedicare Premier Rx (PDP).

Changes in the largest 2017 Medicare Part D formularies
Here are several examples of 2017 stand-alone Medicare Part D plans with the largest formularies and how their formularies are changing in 2018.  (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).
 

2017 Medicare Part D Plans with the Largest Formularies
Plan Name	2018 Formulary Size	2017 Formulary Size	Change in Size	Members Affected
Educators Rx Advantage (PDP)	5,900	5,806	94	582
Blue Rx PDP Plus (PDP)	4,357	4,727	-370	21,084
Blue Rx PDP Complete (PDP)	4,357	4,727	-370	11,984
Magellan Rx Medicare Basic (PDP)	3,471	4,215	-744	106,716
SecureRx - Option 1 (PDP)	4,198	4,163	35	1,518
BlueMedicare Premier Rx (PDP)	3,301	4,112	-811	61,364
BlueMedicare Complete Rx (PDP)	4,191	4,112	79	7,031
BlueRx Option II (PDP)	4,191	4,112	79	21,942
AR Blue Cross - Medi-Pak Rx Premier (PDP)		4,112		9,236
First Health Part D Premier Plus (PDP)	5,256	3,812	1,444	19,497

Although six of the largest 2017 drug plan formularies shown in the table above are offered by "Blue" plans, several of the 2018 Medicare Part D plans with the smallest formularies are also Blue plans.


Please remember:  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 2018 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/2018.  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 drug 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/2018. 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 42 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 medication.

For a stand-alone Medicare prescription drug plan example, click here to review the 21 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 2018 Medicare Part D and Medicare Advantage plans that most affordably meet their health and prescription needs.