Your Medicare Part D plan's cost-sharing structure (how the plan's formulary is divided into drug tiers and the cost-sharing per tier) directly influences your medication costs. When a new drug tier is added into the design, the drugs on the previous tiers are moved, some to lower costing tiers and others to higher costing tiers.
Eighteen 2015 Medicare Part D plans changed their cost-sharing structure for 2016 prescription drug purchases. These plans include:
Plan Name |
Nbr
of
Cost-Sharing Tiers |
Members |
2015 |
2016 |
2015 |
2016 |
Anthem Blue
Cross MedicareRx Gold (PDP) |
5 |
6 |
39,784 |
38,692 |
Anthem Blue
Cross MedicareRx Plus (PDP) |
5 |
6 |
40,883 |
39,935 |
Anthem Blue
Cross MedicareRx Standard (PDP) |
5 |
6 |
37,798 |
38,031 |
Anthem Blue
MedicareRx Plus (PDP) |
5 |
6 |
52,564 |
51,172 |
Anthem Blue
MedicareRx Premier (PDP) |
5 |
6 |
29,625 |
29,001 |
Anthem Blue
MedicareRx Standard (PDP) |
5 |
6 |
46,489 |
47,132 |
Asuris
Medicare Script Basic (PDP) |
5 |
6 |
5,513 |
5,323 |
Asuris
Medicare Script Enhanced (PDP) |
5 |
6 |
1,818 |
1,752 |
BCBSGa Blue
MedicareRx Plus (PDP) |
5 |
6 |
7,382 |
7,177 |
BCBSGa Blue
MedicareRx Premier (PDP) |
5 |
6 |
5,034 |
4,862 |
BCBSGa Blue
MedicareRx Standard (PDP) |
5 |
6 |
10,141 |
10,184 |
Blue
MedicareRx Plus (PDP) |
5 |
6 |
19,019 |
18,100 |
Blue
MedicareRx Premier (PDP) |
5 |
6 |
9,165 |
8,710 |
Blue
MedicareRx Value (PDP) |
5 |
6 |
15,988 |
15,469 |
Regence
Medicare Script Basic (PDP) |
5 |
6 |
3,678 |
3,507 |
Regence
Medicare Script Enhanced (PDP) |
5 |
6 |
1,253 |
1,222 |
SilverScript
Choice (PDP) |
4 |
5 |
3,298,354 |
3,810,908 |
SilverScript
Plus (PDP) |
4 |
5 |
124,563 |
123,544 |
For example, the SilverScript Choice plan added a "Preferred Generic" tier as Tier One and the former
"Generic" tier will become Tier Two in 2016.
As can be seen in the following example, the 2015 SilverScript Choice plan formulary covered 671 medications as Tier One "Generic" medications (with an $8 co-pay).
In comparison, the 2016 SilverScript Choice plan formulary covers 102 medications as Tier One "Preferred Generics" (with an $3 co-pay) and 444 drugs as Tier Two "Generics" (with an $17 co-pay).
California SilverScript Choice
2015 and 2016 Medicare Part D plan Cost-sharing Comparison
|
|
2015 |
2016 |
Monthly Premium |
$22.20 |
$23.10 |
Initial Deductible |
$0 |
$0 |
Gap Coverage |
No Gap Coverage |
No Gap Coverage |
Tier |
2015
Cost-Sharing |
Drugs
on Tier |
Tier |
2016
Cost-Sharing |
Drugs
on Tier |
-- |
-- |
|
|
1 |
Preferred Generic |
$3
|
102 |
1 |
Generic |
$8 |
671 |
2 |
Generic |
$17 |
444 |
2 |
Preferred Brand |
$41 |
1,071 |
2 |
Preferred Brand |
$46 |
924 |
3 |
Non-Preferred Brand |
43% |
902 |
3 |
Non-Preferred Brand |
47% |
1,076 |
4 |
Specialty Tier |
33% |
399 |
4 |
Specialty Tier |
33% |
425 |
Total Formulary Drugs
|
Browse 2015 Formulary |
3,043 |
|
Browse 2016
Formulary |
2,971 |
There were approximately 3,298,354 members in the 2015 SilverScript Choice plan and an additional 124,563 members in the
SilverScript Plus plan that are seeing a similar change in their cost-sharing structure.
If you would like to learn how the Generics were sorted between the 2016 Generic and Preferred Generic tiers, you
can
click
here to browser the California SilverScript Choice 2016 Formulary.
To compare annual changes in Medicare plans, our
PDP-Compare
and
MA-Compare
tools show the 2015 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 were merged, discontinued, or added in 2016.