Over 1.1 million Medicare beneficiaries will see at least 100 fewer medications on their 2022 Medicare Part D drug plan formulary
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.)
The
largest increase in stand-alone prescription drug plan
formulary size is the
SilverScript Plus
plan with the addition of 200 NDCs bring their formulary size up to 3,260 in 2022 from 3,060 in 2021.
However, over 2 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
BlueMedicare Complete Rx (PDP) will lose 844 NDCs from their formulary.
Changes in the largest 2021 Medicare Part D formularies for 2022
Here are several examples of 2021 stand-alone Medicare Part
D plans with the largest formularies and how their formularies are
changing in
2022. (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).
2021 Medicare Part D Plans with the
Largest Formularies and Change for 2022
|
Plan Name |
2022 Formulary Size
|
2021 Formulary Size |
Change
in Size |
Members Affected |
AL TN BlueRx Enhanced Plus (PDP) |
4,367 |
4,330 |
37 |
17,475 |
FL BlueMedicare Complete Rx (PDP) |
3,486 |
4,330 |
-844 |
7,058 |
PA WV Blue Rx PDP Plus (PDP) |
4,160 |
4,185 |
-25 |
14,158 |
PA WV Blue Rx PDP Complete (PDP) |
4,160 |
4,185 |
-25 |
8,202 |
AZ Blue MedicareRx Enhanced (PDP) |
2,834 |
3,578 |
-744 |
1,056 |
SilverScript SmartRx (PDP) |
3,586 |
3,564 |
22 |
718,886 |
AARP MedicareRx Preferred (PDP) |
3,571 |
3,523 |
48 |
1,768,090 |
PA WV SecureRx - Option 1 (PDP) |
3,539 |
3,478 |
61 |
2,287 |
Wellcare Value Script (PDP) |
3,435 |
3,466 |
-31 |
782,989 |
NJ Horizon Medicare Blue Rx Enhanced (PDP) |
3,502 |
3,457 |
45 |
14,620 |
Although many of the largest 2021 drug plan formularies shown in the
table above are offered by "Blue" plans, several of the 2022 Medicare
Part D plans with the smallest formularies are also Blue plans.
2022 Medicare Part D Plans with the
Smallest Formularies |
Plan Name |
2022 Formulary Size
|
2021 Formulary Size |
Change
in Size |
Members Affected |
NC Blue Medicare Rx Standard (PDP) |
2,720 |
2,749 |
-29 |
8,165 |
AR BlueMedicare Premier Rx (PDP) |
2,720 |
2,749 |
-29 |
56,196 |
NJ Horizon Medicare Blue Rx Standard (PDP) |
2,720 |
2,675 |
45 |
6,740 |
AR BlueMedicare Value Rx (PDP) |
2,732 |
2,675 |
57 |
16,527 |
MI Prescription Blue Select (PDP) |
2,768 |
2,819 |
-51 |
4,955 |
AL TN BlueRx Essential (PDP) |
2,806 |
2,749 |
57 |
14,399 |
ID UT Regence Medicare Script Basic (PDP) |
2,806 |
2,749 |
57 |
1,886 |
OR WA Asuris Medicare Script Basic (PDP) |
2,806 |
2,749 |
57 |
2,900 |
PA WV SecureRx - Option 3 (PDP) |
2,806 |
2,749 |
57 |
1,670 |
AZ Blue MedicareRx Enhanced (PDP) |
2,834 |
3,578 |
-744 |
1,056 |
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 2022 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/2022. 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/2022. 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 40 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 2022 Medicare
Part D and Medicare Advantage plans that most affordably meet their health and prescription needs.