General Part D Information + Updates from Q1Medicare.com

Medicare Part D prescription drug plans are permitted under CMS (Medicare) rules to update their plan formulary or drug list throughout the plan year when a new generic enters the market. In such instances, the name brand that the generic replaces can be dropped from the formulary, even during the plan year.

The plans still must conform to CMS (Medicare) requirements. For example, should a generic medication be approved for use, the equivalent brand name drug can be added to a plan’s formulary. Some plans, may continue to cover the name brand medication, if you have already had that medication prescribed for you.

You may not be notified in advance by your drug plan that a brand name drug that you are taking is being dropped. If your brand-name drug is being replaced with a new generic — or if the FDA immediately halts the use of a drug for safety reasons, the formulary change can take effect immediately and without notice.

However, your Medicare Part D plan will provide you with a 30-day notice or a 30-day refill for any other negative formulary change to a medication you are using. For example, your brand-name drug is being replaced with an existing generic.

This spring, 179 prescription drugs were added to one or more Medicare Part D formularies.  The March 2019 formulary update included 198 new National Drug Codes (NDCs) representing variations of 137 different drugs. The April 2019 update included 70 new NDCs representing variations of 42 different drugs.

Generics, which for the most part refers to medications produced by more than one manufacturer, can appear in different plan formularies in different tiers. In fact, for any given plan, you may find generics in all tiers.

You will need to look carefully at your plan’s coverage costs as some 2019 generics are being offered on the same cost-sharing formulary tier as their brand-name equivalent and/or the new generics do not have a significantly lower retail price.  Read more in the Q1Medicare article: Generics don’t always mean lower prices.

If you lose a brand name medication, even if a generic equivalent replaces it, please consult with the provider that prescribed the original drug. It may turn out that the provider is fine with you replacing the brand name with the generic, or the provider may wish to prescribe a different medication.

Secondly, you can always request a Formulary or Tier Exception from your drug plan. If your request is denied, you do have appeal rights. As your Medicare advisor, I can always assist with these procedures.

Highlights of new brand-name drugs that are widely available on Medicare Part D plan formularies include:


Brand-Name Drug
Number of
PDP
Formularies
Number of
MAPD
Formularies
ALUNBRIG 30 MG TABLET 62 353
BRAFTOVI 50 MG CAPSULE 62 353
COPIKTRA 15 MG CAPSULE 62 353
DELSTRIGO 100-300-300 MG TABLET 62 353
EPIDIOLEX 100 MG/ML SOLUTION 62 353
LENVIMA 4 MG CAPSULE 62 353
LORBRENA 25 MG TABLET 62 353
MAGNESIUM SULFATE 50% VIAL 57 344
MEKTOVI 15 MG TABLET 62 353
MOLINDONE HCL 10 MG TABLET 62 344
NAFCILLIN 2 GM VIAL 54 331
NUPLAZID 10 MG TABLET 62 353
ORKAMBI 150-188 MG GRANULE PACK 56 316
PIFELTRO 100 MG TABLET 62 353
ROWEEPRA 500 MG TABLET 55 321
SYMTUZA 800-150-200-10 MG TABLET 62 353
TALZENNA 1 MG CAPSULE 62 353
TIBSOVO 250 MG TABLET 62 353
VALCHLOR 0.016% GEL 62 353
VANCOMYCIN HCL 750 MG VIAL 59 330
VIENVA-28 TABLET 54 310
VITRAKVI 100 MG CAPSULE 59 325
VIZIMPRO 45 MG TABLET 62 353
XARELTO 2.5 MG TABLET 61 338
XOLAIR 75 MG/0.5 ML SYRINGE 58 316
ZORTRESS 1 MG TABLET 62 353

Here are some interesting new generics::


Generic Drug Equivalent [Brand-Name Drug]
Number of
PDP
Formularies
Number of
MAPD
Formularies
ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA] 55 284
ALENDRONATE SODIUM 35 MG TABLET [Fosamax] 62 353
AMLODIPINE BESYLATE 5 MG TABLET [Norvasc] 62 353
AMLODIPINE-BENAZEPRIL 10-40 MG Capsule [Lotrel] 53 347
CEFEPIME HCL 2 GRAM VIAL [Maxipime] 60 351
CLOBAZAM 10 MG TABLET [ONFI] 62 353
DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra] 58 341
HYDROCORTISONE 10 MG TABLET [Hydrocortone] 62 353
KETOROLAC 0.4% OPHTH SOLUTION Drops [Acular LS] 62 352
LAMOTRIGINE 25 MG TABLET [Subvenite] 62 353
LEVOFLOXACIN 500 MG/20 ML VIAL [Levaquin] 59 343
LIOTHYRONINE SOD 50 MCG TABLET [Cytomel] 62 353
MORPHINE SULF 10 MG/5 ML Solution [MSIR] 56 333
NITROFURANTOIN MONO-MCR 100 MG CAPSULE [Macrobid] 60 347
OXYCODONE-ACETAMINOPHEN 10-325 TABLET [Percocet] 62 353
POTASSIUM CL 10% (20 MEQ/15ML) Liquid [Kay Ciel] 62 353
PRIMIDONE 250 MG TABLET [Mysoline] 62 353
RIZATRIPTAN 5 MG TABLET [Maxalt] 62 339
SIMVASTATIN 5 MG TABLET [Zocor] 62 353
SOTALOL 120 MG TABLET [Sorine] 62 345
TELMISARTAN 20 MG TABLET [Micardis] 51 314
TENOFOVIR DISOP FUM 300 MG TABLET [Viread] 62 352
TRANYLCYPROMINE SULF 10 MG TABLET [Parnate] 62 353
TRI-ESTARYLLA TABLET [Trinessa] 52 300
VORICONAZOLE 200 MG TABLET [VFEND] 62 353

Click here for more information on the April changes.

Recent Posts

Archives