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Medicare Part D in 2018: The Latest on Enrollment, Premiums, and Cost Sharing

Table 1: Top 10 Firms Offering Medicare Part D Plans Ranked by 2018 Enrollment
Name of firm Rank Enrollment (in millions) % of total Part D
PDP MA-PD Total
UnitedHealth Group 1 5.3 4.7 10.0 23%
Humana 2 4.9 3.0 7.9 18%
CVS Health 3 6.0 0 6.0 14%
Aetna 4 2.1 1.3 3.4 8%
BCBS* 5 1.0 1.9 2.9 7%
Express Scripts 6 2.4 0 2.4 6%
WellCare Health Plans 7 1.1 0.5 1.6 4%
Kaiser Permanente 8 0 1.5 1.5 4%
Cigna 9 0.8 0.4 1.2 3%
Anthem BCBS 10 0.4 0.6 1.0 2%
Total top 10 firms 24.2 13.9 38.1 88%
Total Part D 25.1 18.3 43.4 100%
NOTE: PDP is prescription drug plan. MA-PD is Medicare Advantage prescription drug plan. Includes enrollment in the territories and employer group plans. Number may not sum to total due to rounding. *BCBS excludes Anthem BCBS, which is a separate plan sponsor.
SOURCE: KFF analysis of CMS 2018 Part D plan files.
Table 2: Top Firms Offering Medicare Part D Plans by State, 2018
State/ territory Total
Part D enrollment
#1 firm % of total #2 firm % of total #3 firm % of total Top 3 firms % of total All other firms % of total
AK 35,152 Humana 40% UnitedHealth 30% CIGNA 12% 81% 19%
AL 730,549 UnitedHealth 25% Humana 17% BCBS 17% 59% 41%
AR 429,440 CVS Health 24% Humana 22% UnitedHealth 16% 62% 38%
AS 95 CVS Health 34% UnitedHealth 32% Aetna 23% 88% 12%
AZ 915,596 UnitedHealth 39% Humana 18% CVS Health 8% 65% 35%
CA 4,777,625 Kaiser Foundation Health Plan 24% UnitedHealth 22% CVS Health 12% 57% 43%
CO 622,279 UnitedHealth 36% Humana 22% Kaiser Foundation Health Plan 18% 76% 24%
CT 516,578 UnitedHealth 35% CVS Health 12% Aetna 12% 60% 40%
DC 55,006 UnitedHealth 31% CVS Health 14% Kaiser Foundation Health Plan 11% 57% 43%
DE 146,584 UnitedHealth 26% Express Scripts 23% Humana 14% 63% 37%
FL 3,299,357 UnitedHealth 27% Humana 26% CVS Health 15% 69% 31%
GA 1,186,871 UnitedHealth 32% Humana 20% CVS Health 16% 68% 32%
HI 185,910 CVS Health 25% UnitedHealth 19% BCBS 18% 63% 37%
IA 463,528 Humana 30% BCBS 18% UnitedHealth 17% 65% 35%
ID 212,023 Humana 23% UnitedHealth 22% BCBS 14% 59% 41%
IL 1,598,234 UnitedHealth 25% Humana 19% BCBS 16% 60% 40%
IN 921,327 Humana 26% UnitedHealth 24% CVS Health 14% 64% 36%
KS 361,451 Humana 32% Aetna 20% CVS Health 20% 72% 28%
KY 671,121 Humana 36% CVS Health 15% Express Scripts 13% 63% 37%
LA 628,819 Humana 36% CVS Health 16% PH Holdings, LLC 10% 62% 38%
MA 988,022 CVS Health 22% UnitedHealth 15% Anthem BCBS 13% 49% 51%
MD 615,389 CVS Health 26% UnitedHealth 20% Humana 12% 58% 42%
ME 233,896 UnitedHealth 28% Martin’s Point Health Care 18% WellCare Health Plans 13% 59% 41%
MI 1,577,228 UnitedHealth 21% Express Scripts 16% BCBS 13% 50% 50%
MN 745,107 BCBS 26% Humana 24% UCare Minnesota 12% 61% 39%
MO 890,815 UnitedHealth 24% Humana 21% Aetna 17% 63% 37%
MS 416,961 Humana 31% CVS Health 24% WellCare Health Plans 15% 70% 30%
MT 142,912 Humana 39% BCBS 20% CVS Health 15% 74% 26%
NC 1,410,633 UnitedHealth 32% Humana 22% CVS Health 14% 68% 32%
ND 86,636 Humana 31% CVS Health 24% BCBS 13% 69% 31%
NE 236,212 Humana 33% UnitedHealth 19% CVS Health 17% 69% 31%
NH 189,952 UnitedHealth 28% Humana 17% CVS Health 12% 58% 42%
NJ 1,163,696 UnitedHealth 41% CVS Health 13% Humana 11% 65% 35%
NM 285,307 UnitedHealth 24% Presbyterian Healthcare Services 15% Humana 14% 53% 47%
NV 344,086 UnitedHealth 39% Humana 31% Aetna 8% 79% 21%
NY 2,733,417 UnitedHealth 20% CVS Health 18% Express Scripts 7% 46% 54%
OH 1,767,794 Humana 18% UnitedHealth 17% Express Scripts 13% 47% 53%
OK 469,737 CVS Health 26% Humana 21% UnitedHealth 18% 65% 35%
OR 607,487 UnitedHealth 18% Centene Corporation 11% Humana 11% 40% 60%
PA 2,047,633 BCBS 18% CVS Health 15% Aetna 12% 45% 55%
PR 575,911 Medical Card System 35% InnovaCare Inc. 34% BCBS 19% 88% 12%
RI 162,225 BCBS 32% UnitedHealth 24% CVS Health 9% 65% 35%
SC 732,424 UnitedHealth 29% Humana 22% CVS Health 15% 65% 35%
SD 111,201 Humana 43% CVS Health 17% BCBS 13% 73% 27%
TN 977,307 Humana 25% UnitedHealth 20% BCBS 15% 60% 40%
TX 2,839,293 UnitedHealth 30% Humana 19% CVS Health 16% 65% 35%
UT 262,839 UnitedHealth 37% Humana 17% Intermountain Health Care 9% 63% 37%
VA 914,191 Humana 32% UnitedHealth 19% CVS Health 14% 65% 35%
VI 11,655 UnitedHealth 98% CIGNA 2% Express Scripts 0% 100% 0%
VT 103,432 UnitedHealth 28% CVS Health 19% Humana 17% 63% 37%
WA 836,641 UnitedHealth 30% Humana 17% CVS Health 10% 57% 43%
WI 807,064 UnitedHealth 31% Humana 21% CVS Health 10% 62% 38%
WV 296,780 Humana 37% CVS Health 16% UnitedHealth 13% 65% 35%
WY 63,933 Humana 32% UnitedHealth 22% CVS Health 18% 72% 28%
NOTE: Includes enrollment in the territories and employer-only group plans. Excludes Guam, where only two firms are operating in 2018. *BCBS excludes Anthem BCBS, which is a separate plan sponsor.
SOURCE: KFF analysis of CMS 2018 Part D plan files.
Table 3: Top 10 Medicare Part D Plans Ranked by 2018 Enrollment
Name of plan 2018 2017 Change, 2017-2018
Type of benefit Rank Enrollment
(in millions)
% of total Part D Rank
SilverScript Choice Basic 1 4.6 12.5% 1 +7%
AARP MedicareRx Preferred Enhanced 2 2.6 7.0% 2 -12%
Humana Walmart Rx Plan Enhanced 3 2.4 6.5% 3 +6%
Humana Preferred Rx Plan Basic 4 1.7 4.6% 4 -9%
Aetna Medicare Rx Saver Basic 5 1.2 3.2% 5 +4%
WellCare Classic Basic 6 1.0 2.8% 7 +0.2%
Humana Enhanced Enhanced 7 0.8 2.2% 8 -13%
AARP MedicareRx Saver Plus Basic 8 0.7 1.9% 6 -35%
Symphonix Value Rx Basic 9 0.7 1.9% 13 +70%
AARP MedicareRx Walgreens Enhanced 10 0.6 1.6% 14 +72%
NOTE: Excludes employer-group only (EGWP) plans; in 2018, one EGWP (Express Scripts Medicare PDP) had 1.7 million enrollees. Plan names can change from year to year; plans are designated the same if they have the same contract/plan ID.
SOURCE: KFF analysis of CMS 2017-2018 Part D plan files.
Table 4: Distribution of Medicare Part D Enrollment by Deductible and Cost-Sharing Amounts, 2018
  All Part D Enrollment PDP
Enrollment
MA-PD Enrollment
Deductible
None 45% 45% 45%
Partial 26% 9% 52%
Standard 29% 46% 3%
Cost sharing
Preferred generics
$0 21% 19% 24%
>$0 to <$3 33% 41% 19%
$3 to <$6 35% 31% 43%
$6 to <$10 11% 9% 13%
$10 to <$12 <1% 0% <1%
$12 to <$15 0% 0% 0%
$15 <1% 0% <1%
Other (non-preferred) generics
$0 2% 1% 3%
>$0 to <$3 13% 21% <1%
$3 to <$6 20% 26% 11%
$6 to <$10 15% 15% 15%
$10 to <$12 14% 10% 20%
$12 to <$15 19% 17% 22%
$15 to $20 17% 10% 28%
Preferred brands
$0 to <$35 20% 33% 4%
$35 to <$40 19% 29% 7%
$40 to <$45 27% 27% 26%
$45 to $47 34% 11% 63%
Non-preferred brands/drugs (coinsurance)
24% to <35% 12% 12%
35% to <40% 35% 38%
40% to <46% 30% 30%
46% to <50% 17% 17%
50% 6% 3%
Non-preferred brands/drugs (copayment)
$5 to <$80 6% 6%
$80 to <$90 5% 5%
$90 to <$95 7% 7%
$95 to <$100 34% 35%
$100 47% 48%
Specialty tier
25% 33% 47% 11%
>25% to <33% 23% 8% 47%
33% 44% 45% 42%
NOTE: PDP is prescription drug plan. MA-PD is Medicare Advantage prescription drug plan. Excludes enrollees in employer-only group plans and Special Needs Plans. Excludes plans with missing data. ‘–‘ indicates data not shown for this plan type since the majority of these plans use the alternative cost-sharing arrangement (coinsurance or copayment) for non-preferred brands/drugs.
SOURCE: KFF analysis of CMS 2018 Part D plan files.
Table 5: Cost Sharing for Medicare Part D Plans, 2010 and 2018
Formulary tier Plan type 2010 2018
Minimum Mean Median Maximum Minimum Mean Median Maximum
Preferred generic PDP $0 $5 $6 $15 $0 $2 $1 $9
MA-PD $0 $6 $7 $15 $0 $3 $3 $15
Generic PDP $13 $27 $26 $37 $0 $7 $6 $20a
MA-PD $0 $15 $10 $38 $0 $11 $12 $20a
Preferred brand copayment
% of enrollees in plans charging
PDP $16.25 $33 $34 $45 $18 $37 $37 $47a
46% 77%
MA-PD $0 $34 $35 $55 $0 $43 $45 $47a
99% 99%
Preferred brand coinsurance
% of enrollees in plans charging
PDP 10% 22% 22% 33% 10% 21% 20% 25%a
54% 23%
MA-PD 23% 24% 23% 40% 15% 22% 25% 25%a
1% 1%
Non-preferred drug copayment
% of enrollees in plans charging
PDP $40 $80 $75 $98 $70 $85 $93 $100a
65% <1%
MA-PD $10 $70 $80 $95 $5 $95 $99 $100a
99% 88%
Non-preferred drug coinsurance
% of enrollees in plans charging
PDP 25% 57% 55% 75% 24% 39% 40% 50%a
35% ~100%
MA-PD 25% 39% 50% 60% 24% 44% 46% 50%a
1% 12%
Specialty PDP 25% 29% 30% 33% 25% 29% 27% 33%a
MA-PD 25% 31% 33% 33% 25% 30% 31% 33%a
NOTE: PDP is prescription drug plan. MA-PD is Medicare Advantage prescription drug plan. Part D estimates weighted by enrollment in each year. Mean and median amounts are weighted by enrollment. Excludes Special Needs Plans and plans with missing data. aThis is the maximum copayment/coinsurance amount allowed by CMS for 2018.
SOURCE: KFF analysis of CMS 2010 and 2018 Part D plan files.
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