![]() ![]() ![]() Copayments for brand-name drugs are higher than those typically charged by large employer plans, while copayments for generics are lower.For example, median cost sharing for preferred and non-preferred brands in MA-PD plans is $45 and $95, respectively, compared to $38 and $80 in PDPs. On average, MA-PD plan enrollees pay somewhat higher cost sharing for their drugs than PDP enrollees, particularly for brand-name drugs.In the same period, cost sharing for generics decreased. Cost sharing for brands increased between 20 by about 36 percent for beneficiaries enrolled in PDPs and by nearly 70 percent for those in MA-PD plans.The vast majority of all Part D enrollees (80 percent of PDP enrollees and 91 percent of MA-PD enrollees) are in plans that use five cost-sharing tiers, a design that gained popularity starting in 2012.Ĭost sharing for brand-name drugs has been relatively stable in recent years, but has risen substantially since the start of Part D MA-PD plan enrollees generally pay somewhat higher cost sharing than PDP enrollees.Part D Benefit Design and Cost Sharing In 2015, most plans use five cost-sharing tiers: preferred and non-preferred tiers for generic drugs, preferred and non-preferred tiers for brand drugs, and a tier for specialty drugs. Average PDP premium for plans with the basic benefit are $16.97 in New Mexico and $36.90 in the Idaho/Utah region. One source of variation is geographic differences.Premiums vary for plans with equivalent benefits, ranging from $12.60 to $101.40 per month for plans offering the basic Part D benefit.PDP premiums vary widely across plans and across regions. By contrast, the SilverScript Choice PDP lowered its premium by 21 percent (an average decrease of about $6 per month) in 2015. Humana’s Walmart Rx PDP, which was new in 2014, raised its premiums by 24 percent (an average increase of about $3 per month) in 2015. ![]() Premiums for some of the most popular plans increased in 2015, while for others, premiums fell. PDP enrollees pay $37.02 per month, on average, in 2015, whereas enrollees in MA-PD plans pay only $17.29.The combined average for PDP and MA-PD plan enrollees is $30.02 in 2015.Part D Premiums Average monthly PDP premiums have been essentially flat since 2010 MA-PD premiums have risen modestly in the past few years. UnitedHealth, by itself, has maintained the top position for all ten years of the program, and in 2015 provides coverage to more than one in five PDP and MA-PD enrollees. UnitedHealth and Humana have topped enrollment since the program began, while enrollment in CVS Health has grown through acquisition of other plan sponsors. This level of market concentration is relatively unchanged since 2006. UnitedHealth, Humana, and CVS Health have enrolled half of all participants in Part D.In 2015, three Part D sponsors account for half of all Part D PDP and MA-PD enrollees. Between 20, the average number of PDPs offered to enrollees dropped from 35 to 30 plans, while the number of MA-PD plans per enrollee increased slightly from 14 to 15 plans. The average number of PDPs offered to enrollees has dropped from a high of 55 plans in 2007 to 30 plans in 2015.The average Part D enrollee had a choice of 30 PDPs and 15 MA-PD plans in 2015. Enrollment in employer-only Part D plans has quadrupled since 2006. In 2015, 6.6 million Medicare beneficiaries are enrolled in an employer-only Part D plan designed solely for retirees of a former employer.MA-PD plan enrollment accounts for two-thirds of the net increase in Part D enrollment from 2014 to 2015, and the share of MA-PD enrollment has grown over the past decade from 28 percent to 39 percent. The majority (61 percent) of Part D enrollees are in PDPs, but enrollment in MA-PD plans is growing more rapidly.Since 2006, the share of Medicare beneficiaries enrolled in a Part D plan has increased from 53 percent to 72 percent of all eligible Medicare beneficiaries. Key Findings Part D Enrollment and Plan Availability In 2015, more than 39 million Medicare beneficiaries are enrolled in Medicare drug plans. This report presents findings from an analysis of the Medicare Part D marketplace in 2015 and changes in features of the drug benefit offered by Part D plans since 2006. Now in its tenth year, Part D has evolved due to changes in the private plan marketplace and the laws and regulations that govern the program. Since 2006, Medicare beneficiaries have had access through Medicare Part D to prescription drug coverage offered by private plans, either stand-alone prescription drug plans (PDPs) or Medicare Advantage prescription drug plans (MA-PD plans). ![]()
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