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:
|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|
|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]
|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|