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Q1Medicare.com Reports the 2021 Medicare Formulary Changes

The April 2021 Medicare Part D plan formulary (or drug list) updates included 135 new drug codes or NDCs representing 95 different medications, including 26 new generics.

The NDC uniquely identifies a particular manufacturer, drug-strength, and packaging combination. The NDC is often shown on your prescription bottle as an 11-digit code (see the charts below) or could be formatted as 00000-0000-00 where the first set of numbers identifies the manufacturer, the second set of number identifies the drug and strength, and the third set of numbers identifies the packaging.

This article highlights the change for some of the “top Medicare drugs”, including their generic equivalents.  The generics included are Atorvastatin [Lipitor®] , Clopidogrel [Plavix®], Escitalopram [Lexapro®], Esomeprazole Sodium [Nexium®], Pioglitazone [Actos®], Risedronate Sodium [Actonel®], Quetiapine Fumarate [Seroquel®], and Valsartan-HCTZ [Diovan HCT®].

The changes to the number of formularies covering these medications looks as follows:

Count of 2021 Formularies Covering the Top Medicare Drugs Program-wide
		Formulary Count*
Drug Name	2015 End**	2016 End**	2017 End**	2018 End**	2019 End**	2020 End**	2021 Start**	April
ACTONEL 35 MG TABLET	148	25	11	13	8	11	3	3
ACTOS 30 MG TABLET	35	23	16	16	16	15	13	13
ADVAIR DISKUS MIS 250/50	353	348	371	370	361	312	290	293
ATORVASTATIN 10 MG TABLET [Lipitor]	394	385	389	394	406	454	453	459
CLOPIDOGREL 75 MG TABLET [Plavix]	394	385	389	394	406	454	453	459
DIOVAN HCT 160/12.5MG TABLET	50	29	21	54	17	18	13	13
ESCITALOPRAM 10 MG TABLET [Lexapro]	385	385	389	394	406	454	453	459
ESOMEPRAZOLE MAG DR 40 MG CAP [Nexium]	285	302	305	315	309	353	362	374
LANTUS 100U/ML VIAL	382	371	382	309	306	364	359	365
LEXAPRO 10MG TABLET	45	26	12	21	14	12	13	13
LIPITOR 10MG TABLET	30	21	20	21	19	16	11	11
NEXIUM DR 40 MG CAPSULE	206	98	33	19	19	10	11	11
PIOGLITAZONE HCL 30 MG TABLET [Actos]	394	385	389	394	406	454	453	459
PLAVIX 75 MG TABLET	34	20	13	16	75	10	11	11
QUETIAPINE FUMARATE 25 MG TAB [Seroquel]	394	385	389	394	406	454	453	459
RISEDRONATE SODIUM 35 MG TAB [Actonel]	220	246	239	249	287	335	357	363
SEROQUEL 25MG TABLET	43	26	12	14	9	10	11	11
VALSARTAN-HCTZ 160-12.5 MG TABLET [Diovan HCT]	388	376	382	391	403	451	448	454

*The number of formularies counts the unique formularies that offer this medication. As a note, the same formulary can be used by one or many different Medicare Part D plans. The same formulary can be used by both stand-alone prescription drug plans (PDP) and Medicare Advantage plans (MAPD).

**Ending CMS formulary dataset are the September dataset. The starting 2021 CMS formulary dataset is dated October, 2020.