November 2, 2022

Anthem, Blue Cross Blue Shield Affiliates, Humana Head List of
Most Member Favorable Part D Values for Commonly Prescribed 
Maintenance Drugs Among Selected $0 Premium 2023 Medicare Advantage Plans

      HealthMetrix Research recently completed the selection of Medicare Advantage (MA+Part D) plans identified as "most member favorable" values for commonly prescribed maintenance drugs among selected $0 premium MA+Part D plans.  The selection recognizes plans whose Part D benefits offer favorable design structure for their members, especially those with chronic health conditions.  Key benefit design elements include:  A) brand and generic formulary selection; B) drug tier classification; C) deductibles, copays, 'donut hole' thresholds.  

      The following 2023 MA+Part D plan sponsors were selected upon compiling Part D data covering 114 markets across 47 states, including Washington DC and Puerto Rico:

    Blue Cross Blue Shield Affiliates -- 23 markets across 13 states; 

    Anthem -- 21 markets across 13 states including Amerigroup affiliate;

    Humana -- 19 markets across 13 states including CarePlus affiliate.

      HealthMetrix Research president This email address is being protected from spambots. You need JavaScript enabled to view it. notes: "This represents forward-looking findings that informed Medicare beneficiaries should find useful in evaluating their MA+Part D plan options, especially in the event their health status deteriorates resulting in increased reliance on maintenance drugs to treat their conditions.  Unfortunately, the Medicare.gov Medicare Plan Finder (MPF) is of limited value and lacks a forecasting tool to compare projected cost-sharing impact for members as their health status changes while enrolled in their MA+Part D plans."

      The principal selection screen was the HealthMetrix Research 2023 CostShare Report that carves out estimated annual cost-sharing for selected Part D maintenance drugs commonly prescribed and filled by 90-day mail order network pharmacies.  Part D estimated cost-sharing is based on member health status categories (excellent, fair, poor) with each category utilizing a basket of commonly prescribed brand and generic maintenance drugs.  A total of 10 chronic conditions were identified as the basis for selecting the basket of brand and generic maintenance drugs.

      HealthMetrix Research neither recommends nor endorses specific Medicare Advantage plans.     

Sources

HealthMetrix Research 2023 CostShare Reports, October 2022.

CMS/Medicare.gov 2023 Medicare Plan Finder, October 2022.

Medicare Part D Drugs-2020, CMS/Office of Enterprise Data & Analytics (OEDA), December 2021.