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. |
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| 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. |
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| 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. |
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| 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. |
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| 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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