Medicare Part D drug plans differ considerably in the drugs they list on their formularies, their use of formulary tiers, and the level and structure of cost sharing applied to those tiers. Plan premiums and the use of deductibles also vary widely. Plan decisions affect different beneficiaries in different ways, depending on the drugs they use. The financial consequences for Part D plan enrollees can be substantial. In this brief, we focus on out-of-pocket drug costs for Part D enrollees in 2016 for specialty, brand, and generic drugs.
The analysis is based on a selected set of specialty drugs and commonly prescribed brand and generic drugs. Out-of-pocket costs are taken from the Medicare Plan Finder, available at medicare.gov, as they apply to Part D enrollees who do not qualify for the Low-Income Subsidy. Drug costs were obtained for 20 prescription drug plans (PDPs) offered on a national or near-national basis, using a location in Baltimore, MD. In addition to examining costs for common drugs, we also examine profiles of multiple drugs for five hypothetical Part D enrollees.
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