Health Plans Announce Changes to Medicare Pharmacy Plans

Aetna, Cigna and UnitedHealthcare are enhancing their Medicare pharmacy benefits, including offering insulin for a copay of no more than $35 for a 30-day supply.

Effective January 2022, Aetna, Cigna and UnitedHealthcare have made similar changes to increase the number of members who have access to Medicare prescriptions plans. Additionally, all three plans are offering insulin for a copay of no more than $35 for a 30-day supply.

Both Aetna and UnitedHealthcare are expanding their coverage of nonprescription products. Aetna is also providing members with the OTC allowance benefit access to nicotine replacement therapy for smoking cessation.

Aetna

Aetna, a CVS company, has expanded its zero premium plan options for its Medicare Advantage plan. Aetna estimates 84% of the Medicare-eligible beneficiaries in the United States will now have access to this benefit.

For 2022, Aetna is offering Medicare Advantage Prescription Drug (MAPD) plans in 46 states plus Washington, D.C. Aetna has added 83 new counties across the country, providing an additional 1 million more Medicare beneficiaries access to an Aetna plan.

For those who qualify for both Medicare and Medicaid benefits, Aetna expanded its Dual Eligible Special Needs Plan (D-SNP) offerings across 27 states, including new markets in Arkansas, Colorado, Delaware and Indiana. Most plans offer prescription drugs at no out-of-pocket cost and additional benefits for members that qualify for Low-Income Subsidy.

Aetna is expanding participation in the Part D Senior Savings model, offering members in some Individual MAPD Plans and all SilverScript Plus Part D plans affordable, predictable copays of no more than $35 for a 30-day supply of select insulins.

Aetna now serves nearly 9.8 million Medicare members nationwide, as of June 30, 2021, with 2.9 million Medicare beneficiaries currently enrolled in Aetna Medicare Advantage.

Aetna is also partnering with PayFlex to offer a new debit card containing funds to use toward copayments for in-network primary and specialist care, and other medical and diagnostic services. Qualifying members will receive $100 per quarter with a $400 per year maximum. This benefit will be included on select Individual MA plans in Pennsylvania and Minnesota.

“The pandemic continues to disrupt so many aspects of our lives, including our health and well-being,” Christopher Ciano, president of Aetna Medicare, said in a statement. “While we're still focused on protecting our members from COVID-19, we also want to help improve their overall physical and mental health. That's why we expanded our Aetna Medicare Solutions portfolio of products to include more benefits designed to make care more affordable, accessible and convenient.”

Cigna

Cigna has increased its geographic presence in Medicare Advantage by 80 percent since 2019. The company now offers plans in 477 counties across 26 states and the District of Columbia.

Cigna is adding the Senior Savings Model to a number of its Medicare Advantage plans for 2022. The program caps the price of insulin at $35 per month for customers in those plans regardless of their coverage phase.

Cigna is offering three stand-alone prescription drug plans across the country for 2022 as it consolidates the former Express Scripts' individual PDP plans. These plans have zero copay options for select medications purchased through preferred home delivery.

The three plans are:

  • Cigna Secure Rx: Available to serve customers with a low-income subsidy in 49 states and the District of Columbia in 2022.
  • Cigna Essential Rx: Offers good value with coverage that includes generic drug savings.
  • Cigna Extra Rx: Provides a high level of coverage and savings on select insulins with copays as low as $0 at a preferred pharmacy.

“Through geographic and product expansion, we're pleased to be able to provide [Medicare] customers with the plan that best fits their personal health care needs, including their lifestyle, health and budget,” Aparna Abburi, president, Cigna Medicare, said in a statement.

UnitedHealthcare

UnitedHealthcare has increased the number of Medicare and other members eligible for its tier 1, zero copay medications. Beginning in January 2022, more than 70% of current members will have access to this benefit at a retail pharmacy, up from 30% in 2021, and almost 60% of members will have access to zero prescription deductibles, up from 40% in 2021.

More than 20 generic drugs are moving to a lower tier, giving members greater access to a wider variety of drugs for a $0 copay.

For Medicare Part D coverage gap plans, all plans will provide tier 1 gap coverage, eliminating increased costs during the coverage gaps. In the Part D Senior Savings Model, more than 5.5 million members will have access to Medicare Advantage and Part D plans that limit monthly out-of-pocket costs to $35 or less for all covered insulin. This year, eligible UnitedHealthcare members have saved an average of nearly $450 through the program.

For dual eligible members, UnitedHealthcare will expand access to $0 copays on covered drugs to 93% of its members enrolled in Dual Special Needs Plans (D-SNP) plans, up from 73% this plan year.

Since late 2020, UnitedHealthcare has offered Rx Online Marketplace, where patients can compare drug prices, manage refills and transfers for pickup or delivery at a retail pharmacy or through OptumRx home delivery. With more than 2.6 million visits since its launch, members saw annual savings on their medications of $467, on average.

“Access to affordable prescription drugs continues to rank high on the list of central expectations of our members. From everyday medications to lifesaving drugs like insulin, our 2022 plans are designed to cover what people tell us they need,” Tim Noel, CEO of UnitedHealthcare Medicare & Retirement, said in a statement.

Currently, more than 7.3 million people are enrolled in UnitedHealthcare Medicare Advantage plans. In 2022, the company will expand its service area to reach 94% of Medicare consumers nationwide.