Comparison of VA National
Formulary and Formularies of the
Highest Enrollment Plans in
Medicare Part D and the Federal
Employee Health Benefit Program
Prepared for:
PhRMA
Submitted by:
The Lewin Group, Inc.
December 10, 2008
Comparison of VA National Formulary
and Formularies of the Highest
Enrollment Plans in Medicare Part D and
the Federal Employee Health Benefit
Program
Prepared for:
PhRMA
Submitted by:
The Lewin Group, Inc.
December 10, 2008
The Pharmaceutical Research and Manufacturers of America asked The Lewin Group to
compare the formulary status of drugs commonly used by the Medicare population on the
Veterans Affairs National Formulary (VA formulary), the two highest enrollment Medicare Part
D plans, and the plan with highest enrollment in the Federal Employee Health Benefit Program
(FEHBP). Lewin first completed this analysis in January 2007 using the 2007 versions of the VA
formulary, Medicare Part D formularies, and FEHBP formulary. This report provides an
update to the 2007 analysis. In addition, we analyzed the tier distribution of the drugs covered
on the Part D formularies.
Lewin identified the drugs most commonly used by the Medicare population by querying
Verispan’s Vector One National Audit (VONA) data to compile the 300 drugs with the highest
script volumes for the 65 and older population.1 Nineteen of the top 300 drugs are not covered
by the Part D program due to statutory or regulatory requirements.2 We conducted the analysis
using the remaining 281 Part D covered drugs.
Key Findings
Overall, coverage of the top Part D covered drugs by the VA formulary, FEHBP formulary, and
the formularies of the two highest enrollment Medicare Part D plans remains largely
unchanged since the 2007 analysis. The FEHBP and Medicare Part D formularies that we
analyzed all provide a greater breadth of drug coverage than the VA formulary. Additionally,
both of the Part D formularies placed close to 90 percent of the top 281 Part D covered drugs on
either tier one or tier two.
Exhibit 1 illustrates the number and percent of scripts covered by the VA, FEHBP, and the two
Medicare Part D formularies for all of the general drug categories that are captured by the top
Part D covered drugs. Exhibit 2 illustrates the formulary status for each of the top 300 drugs.
⇒ Of the 281 Part D covered drugs, 183 (65%) are included in the VA formulary, compared to
273 (97%) in the FEHBP formulary, 278 (99%) in the highest enrollment Part D plan
formulary, and 280 (100%) in the second highest enrollment Part D plan formulary. Of the
116 brand drugs among the 281 Part D covered drugs, 51 (44%) are covered by the VA
formulary, compared to 115 (99%) covered by the FEHBP formulary, 114 (98%) covered by
the highest enrollment Part D plan formulary, and 116 (100%) covered by the second highest
enrollment Part D plan formulary.
⇒ The two highest enrollment Part D plans predominantly place the top 281 Part D covered
drugs on tiers one or two. Of the 278 drugs covered by the highest enrollment Part D plan
formulary, 242 (87%) are on tiers one or two. Of the 280 drugs covered by the second
highest enrollment Part D plan formulary, 248 (89%) are on tiers one or two.
1
The script volume for each drug is from the time period of January 2008 through July 2008.
2
The following drugs excluded from Part D coverage: Alprazolam, Aspirin (enteric-coat), Benzonatate, Cheratussin
AC, Cialis, Clonazepam, Cyanocobalamin, Diazepam, Docusate Sodium, Ferrous Sulfate, Folic Acid, Levitra,
Lorazepam, Phenobarbital, Promethazine/Codeine, Temazepam, Tussionex, Viagra, Vitamin D. The list of Part D
excluded drugs was obtained from: www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/R2PDB.pdf.
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⇒ Of the 569 million scripts analyzed, 72% of the total and 41% of the brand scripts are
covered by the VA formulary. In contrast, 99% of all scripts and 100% of brand scripts are
covered by the FEHBP plan. The highest enrollment Part D plan covers 99% of all scripts
and 99% of brand scripts and the second highest enrollment Part D plan covers 100% of all
scripts and 100% of brand scripts.
⇒ VA formulary coverage varies widely among the drug categories due to the partially closed
nature of the formulary; for example, while 76% of all scripts are covered in the largest
category (cardiovascular), fewer than half of scripts for ear, nose, and throat and urologic
disorders are covered.
Methodology
We downloaded the VA’s National Drug File from the VA pharmacy website3 and checked each
of the 281 Part D covered drugs against those covered by the VA formulary. Since the VA
formulary is organized by generic entity and only includes the names of brand name drugs
when they cannot be substituted due to narrow therapeutic index, all matches were based on
the generic name of the drug. For example, if the brand name of a drug appears on the list of
top drugs and that drug’s generic name is listed on the VA formulary, the brand drug is
counted as being on the VA formulary.
In some cases, the VA formulary covers only certain strengths or forms of a particular drug
(e.g., IV version is covered but the tablets are not covered). In those cases, we looked at the
breakdown of script volume by dosage and form for that drug within the VONA data in order
to determine how many scripts are covered on the VA formulary and how many are excluded.
For the purposes of Exhibit 1, we only counted scripts for a particular drug when those specific
formulations (e.g., capsules, extended release version) were covered. In order to determine
formulary coverage for Exhibit 2, we used the percent of the VONA scripts for that drug that
were actually covered as a proxy for formulary coverage. If more than 90% of the script volume
for a particular drug was covered by the VA formulary, the entire drug was considered as being
covered on the VA formulary. If less than 5% of the script volume for a particular drug was
covered by the VA formulary, the entire drug was labeled as being excluded from the VA
formulary. If between 5% and 90% of the script volume for a particular drug was covered by the
VA formulary, the drug was labeled as having “some forms” on the VA formulary. Using this
methodology, only three drugs4 were labeled as excluded because the VA formulary covered
less than 5% of each drug’s script volume. Drugs meeting the “some forms” or “included”
criterion were counted as being covered on the formulary.
The FEHBP national plan with highest enrollment is the Blue Cross Blue Shield FEP Basic plan.
The FEP basic formulary was obtained from the BCBS Federal Employee Program website.5
Similar to the VA formulary, the FEP Basic formulary does not list all the brand name drugs
covered, but instead is organized by generic entity. Therefore, we matched drugs on the FEP
3
http://www.pbm.va.gov/NationalFormulary.aspx
4
Protonix, famotidine, and labetalol
5
http://www.caremark.com/portal/asset/feprx_807.pdf
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Basic formulary to each of the 281 Part D covered drugs based on the generic form of the drug.
The FEP Basic formulary generally covers or excludes all forms of a drug, so if a drug was
covered on the formulary, we counted all of the scripts for that drug as being covered.
According to CMS data, the two highest enrollment Medicare Part D plans based on October
2008 enrollment are the United AARP MedicareRx Preferred Plan and the Humana Standard
Plan. The United AARP MedicareRx Preferred formulary and Humana Standard formulary
were obtained from each plan’s respective website.6 Unlike the VA and FEHBP formularies, the
format of the Part D formularies allowed us to consider whether the brand form, generic form,
or both are on formulary. Therefore, for example, we only counted the brand version as being
covered if the specific brand name appeared on the Part D plan formulary. If only the generic
name appeared on the plan’s formulary, the brand version was not counted as being on the Part
D plan formulary. Only one drug, Nitroquick, was excluded from the count of Part D covered
drugs due to this different method of counting formulary coverage for the Part D plans. The
United AARP MedicareRx Preferred Plan does not cover Nitroquick, however it does cover the
generic form of the drug, nitroglycerin. Like the FEHBP formulary, the Medicare Part D
formularies generally either cover or exclude all forms of a drug. If a drug was on the Part D
formulary, we counted all of the scripts for that drug as being covered.
Beyond inclusion on the formulary, the tier assignment of a particular drug can impact its
accessibility for the beneficiary. Both the United AARP MedicareRx Preferred plan and the
Humana Standard plan use a four tier formulary structure. In multi-tier formularies, drugs
placed on tiers one or two are considered preferred generic and brand drugs and have lower
cost share requirements than drugs on higher tiers. United AARP MedicareRx Preferred
members pay tiered copayments for drugs on the first three tiers and 33% coinsurance for drugs
on the fourth tier. Humana PDP Standard members pay 25% coinsurance for drugs across all
tiers. While the Humana PDP Standard has a single coinsurance structure, the four tier
formulary structure is the same as those used for Humana’s PDP Enhanced and Complete plans
and reflects which drugs Humana considers preferred brand and generic drugs. We examined
the tier placement of the 281 Part D covered drugs for both of the Part D formularies to see what
percent of these top drugs were placed on a preferred tier.
United AARP formulary from https://www.aarpmedicarerx.com/online_documents/ovation/pdf/pdp/en/2009/
FLPDP3023174_XAPE002.pdf and Humana Standard formulary from
http://apps.humana.com/marketing/documents.asp?file=906360
6
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Exhibit 1: Scripts Covered by the VA, FEHBP, and Two Medicare Part D Formularies, by General Drug Category1
VA National Formulary
General Drug Category
Cardiovascular Agents (High Blood Pressure, Heart Disease)
Gastrointestinal Drugs (Stomach and Intestine Disorders)
Antimicrobials and Infectious Diseases (Infection)
Pain and Inflammatory Diseases (Arthritis, Gout)
Psychiatric
Eye
Respiratory Drugs (Asthma, Emphysema)
Neurological Drugs (Migraine, Parkinson's Disease, Alzheimer's Disease)
Hormone Therapy/Menopause
Ear, Nose and Throat
Hormones (Thyroid, Growth Hormones)
Urologic Disorders
Anticoagulants and Hematopoietics (Blood Modifiers)
Benign Prostatic Hyperplasia
Skin (Acne, Skin Infection, Psoriasis)
Women's Health
Antineoplastics and Immunosuppressants
Supplements
Total - Part D Covered Drugs
Total - Brand Drugs
Count of
Drugs
Total Scripts
(in 000s)
83
35
22
22
20
15
15
14
11
10
9
8
7
4
2
2
1
1
281
116
245,167
63,361
31,015
46,952
34,042
11,635
21,166
19,106
19,411
7,977
28,323
6,044
21,861
8,817
1,845
1,282
601
483
569,088
183,136
Scripts
Covered (in
000s)
185,117
33,273
27,744
33,023
23,072
6,284
14,967
15,473
13,894
3,471
27,705
1,888
20,753
3,788
0
1,282
0
482
412,217
75,143
% Scripts
Covered
76%
53%
89%
70%
68%
54%
71%
81%
72%
44%
98%
31%
95%
43%
0%
100%
0%
100%
72%
41%
FEHBP with Highest
Enrollment Formulary
Scripts
% Scripts
Covered (in
Covered
000s)
243,431
99%
63,361
100%
31,015
100%
46,284
99%
34,042
100%
11,635
100%
21,166
100%
17,562
92%
19,411
100%
7,492
94%
28,323
100%
6,044
100%
21,861
100%
8,817
100%
1,845
100%
1,282
100%
601
100%
483
100%
564,653
99%
182,792
100%
Highest Enrollment Medicare
Part D PDP
Scripts
% Scripts
Covered (in
Covered
000s)
237,780
97%
63,361
100%
31,015
100%
46,952
100%
34,042
100%
11,635
100%
21,166
100%
19,106
100%
19,411
100%
7,977
100%
27,707
98%
5,647
93%
21,861
100%
8,817
100%
1,845
100%
1,282
100%
601
100%
483
100%
560,687
99%
181,436
99%
2nd Highest Enrollment
Medicare Part D PDP
Scripts
% Scripts
Covered (in
Covered
000s)
245,167
100%
63,361
100%
31,015
100%
46,952
100%
34,042
100%
11,635
100%
20,773
98%
19,106
100%
19,411
100%
7,977
100%
28,323
100%
6,044
100%
21,861
100%
8,817
100%
1,845
100%
1,282
100%
601
100%
483
100%
568,695
100%
183,136
100%
Scripts associated with the following Part D excluded drugs are not included in this exhibit: Alprazolam, Aspirin (enteric-coat), Benzonatate, Cheratussin AC,
Cialis, Clonazepam, Cyanocobalamin, Diazepam, Docusate Sodium, Ferrous Sulfate, Folic Acid, Levitra, Lorazepam, Phenobarbital, Promethazine/Codeine,
Temazepam, Tussionex, Viagra, Vitamin D. The list of Part D excluded drugs was obtained from:
http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/R2PDB.pdf.
1
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Exhibit 2: Top 300 Drugs for the 65+ Population by Script Volume, January – July 20081
(highlighted drugs are statutory exclusions from Part D coverage)
65+
Script
Ranking
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
Drug Name
Generic/Active Ingredient
Lisinopril
lisinopril
Simvastatin
simvastatin
Furosemide Oral
furosemide
Lipitor
atorvastatin
Hydrocodone/APAP
hydrocodone/acetaminophen
Levothyroxine
levothyroxine
Amlodipine Besylate
amlodipine besylate
Hydrochlorothiazide
hydrochlorothiazide
Atenolol
atenolol
Metoprolol Succinate
metoprolol succinate
Metoprolol Tartrate
metoprolol tartrate
Plavix
clopidogrel
Warfarin
warfarin
Metformin
metformin
Omeprazole
omeprazole
4
alprazolam
Alprazolam
Nexium
esomeprazole
Triamterene w/HCTZ
triamterene/hydrochlorothiazide
Klor-Con
potassium chloride
Diovan
valsartan
Prednisone Oral
prednisone
Synthroid
levothyroxine
Propoxyphene-N/APAP propoxyphene/acetaminophen
Lovastatin
lovastatin
Potassium Chloride
potassium chloride
Azithromycin
azithromycin
4
lorazepam
Lorazepam
Alendronate
alendronate
Flomax
tamsulosin
Gabapentin
gabapentin
Zolpidem Tartrate
zolpidem tartrate
Carvedilol
carvedilol
Isosorbide Mononitrt
isosorbide mononitrate
Lisinopril/HCTZ
lisinopril/hydrochlorothiazide
Ciprofloxacin HCl
ciprofloxacin hydrochloride
Amoxicillin
amoxicillin
Sertraline
sertraline
Vytorin
ezetimibe
Enalapril
enalapril
Allopurinol
allopurinol
Pravastatin
pravastatin
Advair Diskus
fluticasone/salmeterol
Tramadol
tramadol
Prevacid
lansoprazole
Zetia
ezetimibe
Crestor
rosuvastatin
Actos
pioglitazone
Lexapro
escitalopram
Aricept
donepezil
Diovan HCT
hydrochlorothiazide/valsartan
Actonel
risedronate
Amlodipine Besylate/Benaamlodipine besylate/benazepril
Metformin HCl ER
metformin
Levaquin
levofloxacin
Cephalexin
cephalexin
Celebrex
celecoxib
Xalatan
latanoprost
Cozaar
losartan
Singulair
montelukast
Citalopram HBR
citalopram
Glyburide
glyburide
Ranitidine HCl
ranitidine hydrochloride
Spiriva
tiotropium
Oxycodone w/APAP
oxycodone/acetaminophen
Digoxin
digoxin
Meloxicam
meloxicam
Clonidine
clonidine
Glimepiride
glimepiride
Paroxetine
paroxetine
Verapamil SR
verapamil
Spironolactone
spironolactone
Amitriptyline
amitriptyline
Lantus
insulin glargine
Fexofenadine
fexofenadine
4
folic acid
Folic Acid
4
clonazepam
Clonazepam
Tricor
fenofibrate
Fluoxetine
fluoxetine
Brand/
Generic
G
G
G
B
G
G
G
G
G
G
G
B
G
G
G
G
B
G
B
B
G
B
G
G
G
G
G
G
B
G
G
G
G
G
G
G
G
B
G
G
G
B
G
B
B
B
B
B
B
B
B
G
G
B
G
B
B
B
B
G
G
G
B
G
G
G
G
G
G
G
G
G
B
G
G
G
B
G
Highest
2nd Highest
FEHBP with
Estimated
VA
Enrollment Enrollment
Scripts
Sales
Highest
Sales
National
Medicare
Medicare
For 65+
Ranking
Enrollment
Ranking
Formulary
PDP
PDP
(in 000s)
(all
U.S.)
Formulary
Formulary Formulary
(65+)2
Status3
Status
Tier Status Tier Status
17,591
Y
Y
1/2
1/2
49
67
15,687
Y
Y
1/2
1/2
13
25
14,456
Y
Y
1/2
1/2
109
207
13,908
N
Y
1/2
1/2
1
1
13,770
Y
Y
1/2
1/2
42
17
13,534
Y
Y
1/2
1/2
59
89
12,368
Y
Y
1/2
1/2
26
58
11,962
Y
Y
1/2
1/2
119
157
11,405
Y
Y
1/2
1/2
114
162
11,405
Y
Y
1/2
1/2
16
34
9,856
Y
Y
1/2
1/2
128
210
9,358
Y
Y
1/2
1/2
2
3
8,775
Y
Y
1/2
1/2
60
147
7,649
Y
Y
1/2
1/2
77
105
7,524
Y
Y
1/2
1/2
25
39
139
104
5,682
Y
Y
N
N
5,626
N
Y
1/2
1/2
3
2
5,369
Y
Y
1/2
1/2
184
267
5,052
Y
Y
1/2
1/2
140
260
4,881
Y
Y
1/2
1/2
12
29
4,786
Y
Y
1/2
1/2
183
208
4,763
Y
Y
1/2
1/2
80
93
4,722
N
Y
1/2
1/2
151
197
4,678
Y
Y
1/2
1/2
65
122
4,632
Y
Y
1/2
1/2
135
254
4,612
Y
Y
1/2
1/2
61
27
120
139
4,611
Y
Y
N
N
4,569
Y
Y
1/2
1/2
41
94
4,550
N
Y
1/2
1/2
8
33
4,485
Y
Y
1/2
1/2
48
54
4,458
N
Y
1/2
1/2
63
64
4,326
Y
Y
1/2
1/2
84
158
4,048
Y
Y
1/2
1/2
173
378
3,974
Y
Y
1/2
1/2
165
191
3,952
Y
Y
1/2
1/2
194
217
3,939
Y
Y
1/2
1/2
217
106
3,884
Y
Y
1/2
1/2
99
74
3,855
N
Y
1/2
1/2
9
19
3,679
Y
Y
1/2
1/2
169
264
3,650
Y
Y
1/2
1/2
260
422
3,596
N
Y
1/2
1/2
92
140
3,543
N
Y
1/2
1/2
4
4
3,489
Y
Y
1/2
1/2
157
152
3,459
N
Y
1/2
1/2
7
5
3,445
N
Y
1/2
1/2
15
30
3,424
N
Y
3/4
1/2
14
21
3,402
N
Y
1/2
1/2
5
9
3,375
N
Y
1/2
1/2
21
10
3,345
Y
Y
1/2
1/2
6
35
3,295
N
Y
1/2
1/2
23
32
3,084
Y
Y
1/2
1/2
24
62
3,060
Y
1/2
1/2
27
43
N
2,972
Y
Y
1/2
1/2
180
218
2,872
N
Y
1/2
1/2
19
23
2,854
Y
Y
1/2
1/2
215
170
2,832
N
Y
3/4
1/2
11
22
2,753
N
Y
3/4
1/2
45
111
2,733
Y
Y
3/4
3/4
36
68
2,717
Y
Y
1/2
1/2
22
6
2,712
Y
Y
1/2
1/2
216
176
2,642
Y
Y
1/2
1/2
187
323
2,574
Y
Y
1/2
1/2
195
236
2,567
Y
Y
1/2
1/2
10
36
2,563
some forms
Y
1/2
1/2
130
73
2,529
Y
Y
1/2
1/2
315
610
2,515
N
Y
1/2
1/2
200
253
2,501
Y
Y
1/2
1/2
275
377
2,500
N
Y
1/2
1/2
229
368
2,457
Y
Y
1/2
1/2
141
126
2,447
Y
Y
1/2
1/2
145
231
2,379
Y
Y
1/2
1/2
185
285
2,351
Y
Y
1/2
1/2
377
437
2,343
N
Y
1/2
1/2
18
24
2,261
N
Y
1/2
1/2
75
55
347
492
2,246
Y
Y
N
N
239
160
2,200
Y
Y
N
N
2,172
N
Y
1/2
1/2
30
31
2,157
Y
Y
1/2
1/2
221
134
5
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65+
Script
Ranking
Drug Name
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
Albuterol Aerosol
Doxazosin
Glipizide
Trazodone HCl
Pantoprazole
Premarin Tabs
4
Temazepam
Namenda
Fluticasone Nasal
Benazepril
Detrol LA
4
Diazepam
Ibuprofen
Cyclobenzaprine
Lyrica
Meclizine HCl
Acetaminophen w/Cod
Digitek
Evista
Glipizide ER
Benicar
Naproxen
Levoxyl
Potassium Chloride E
Cartia XT
Terazosin
Hyzaar
Fosamax
Avapro
Quinapril
Diltiazem CD
Ramipril
Nifedipine ER
Trimethoprim/Sulfa
Boniva
Combivent
Finasteride
Methylprednis Tabs
Doxycycline
Effexor XR
Cymbalta
Lanoxin
Coumadin Tabs
Amoxicillin/Pot Clav
Mirtazapine
ProAir HFA
Metoclopramide
Triamcinln Acet Top
Avodart
Seroquel
Gemfibrozil
4
Viagra
Benicar HCT
4
Vitamin D
Nitroglycerin
Felodipine ER
Glybrid/Metfrmin HCl
Protonix
Carbidopa/Levodopa
Januvia
Amiodarone
Propranolol HCl
Nasonex
Fentanyl Transdermal
Nitroquick
Niaspan
Aciphex
Lumigan
Polyethylene Glycol
Alphagan P
Toprol XL
Avalide
4
Aspirin,Enteric-Coat
Albuterol Neb Soln
Promethazine Tabs
Methotrexate
Diclofenac Sodium SR
Lidoderm
Hydralazine
Famotidine
Hydroxyzine
Altace
Generic/Active Ingredient
albuterol
doxazosin
glipizide
trazodone hydrochloride
pantoprazole
estrogens, conjugated
temazepam
memantine
fluticasone
benazepril
tolterodine
diazepam
ibuprofen
cyclobenzaprine
pregabalin
meclizine
acetaminophen/codiene
digoxin
raloxifene
glipizide
olmesartan
naproxen
levothyroxine
potassium chloride
diltiazem
terazosin
hydrochlorothiazide/losartan
alendronate
irbesartan
quinapril
diltiazem
ramipril
nifedipine
trimethoprim/sulfamethoxazole
ibandronate
albuterol/ipratropium
finasteride
methylprednisolone
doxycycline
venlafaxine
duloxetine
digoxin
warfarin
amoxicillin/potassium clavulanate
mirtazapine
albuterol
metoclopramide
triamcinolone acetonide
dutasteride
quetiapine
gemfibrozil
sildenafil
hydrochlorothiazide/olmesartan
vitamin D
nitroglycerin
felodipine
glyburide/metformin
pantoprazole
carbidopa/levodopa
sitagliptin
amiodarone
propranolol
mometasone
fentanyl
nitroglycerin
niacin
rabeprazole
bimatoprost
polyethylene glycol
brimonidine
metoprolol succinate
hydrochlorothiazide/irbesartan
aspirin
albuterol
promethazine
methotrexate
diclofenac sodium
lidocaine
hydralazine
famotidine
hydroxyzine
ramipril
Brand/
Generic
G
G
G
G
G
B
G
B
G
G
B
G
G
G
B
G
G
B
B
G
B
G
B
G
B
G
B
B
B
G
G
G
G
G
B
B
G
G
G
B
B
B
B
G
G
B
G
G
B
B
G
B
B
G
G
G
G
B
G
B
G
G
B
G
B
B
B
B
G
B
B
B
G
G
G
G
G
B
G
G
G
B
Highest
2nd Highest
FEHBP with
Estimated
VA
Enrollment Enrollment
Scripts
Sales
Highest
Sales
National
Medicare
Medicare
For 65+
Ranking
Enrollment
Ranking
Formulary
PDP
PDP
(in 000s)
(all
U.S.)
Formulary
Formulary Formulary
(65+)2
Status3
Status
Tier Status Tier Status
2,155
2,133
2,123
2,122
2,101
2,081
2,041
2,038
1,950
1,921
1,921
1,838
1,803
1,786
1,786
1,745
1,742
1,723
1,722
1,721
1,712
1,696
1,688
1,672
1,672
1,655
1,648
1,644
1,639
1,618
1,598
1,596
1,572
1,550
1,550
1,535
1,526
1,505
1,488
1,465
1,451
1,422
1,408
1,407
1,387
1,366
1,366
1,345
1,322
1,321
1,316
1,312
1,290
1,282
1,266
1,251
1,201
1,195
1,186
1,180
1,155
1,153
1,139
1,112
1,083
1,082
1,075
1,074
1,072
1,040
1,030
1,019
1,015
1,012
1,010
1,001
991
975
970
969
966
958
156
285
330
324
33
72
296
20
123
279
29
346
401
312
28
379
322
423
44
205
68
343
257
271
125
264
56
53
62
189
133
91
106
367
52
50
82
426
376
34
38
358
137
142
222
154
395
414
55
17
255
66
83
349
259
127
188
51
163
37
210
319
90
35
529
57
46
79
240
104
164
98
742
269
396
292
310
32
247
410
273
118
120
520
511
296
40
85
432
83
81
419
66
333
243
203
28
609
290
748
96
349
113
321
328
462
216
494
92
125
119
293
249
127
180
324
95
86
181
395
339
8
13
676
278
51
317
109
493
458
135
7
350
47
100
498
514
229
269
80
367
52
444
398
46
42
875
77
38
188
357
223
271
133
1106
226
310
389
348
44
460
567
282
168
Y
Y
Y
Y
N
Y
Y
Y
N
Y
N
Y
Y
Y
N
Y
Y
Y
N
N
N
Y
Y
Y
N
Y
N
Y
N
N
some forms
N
Y
Y
N
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
N
N
N
some forms
Y
N
N
Y
N
Y
Y
N
Y
Y
Y
N
N
N
Y
Y
N
Y
Y
Y
Y
Y
N
Y
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
1/2
1/2
1/2
1/2
1/2
1/2
N
1/2
1/2
1/2
1/2
N
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
3/4
1/2
3/4
1/2
1/2
1/2
1/2
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
N
1/2
N
1/2
1/2
1/2
1/2
1/2
3/4
1/2
1/2
1/2
1/2
N
1/2
3/4
1/2
1/2
1/2
3/4
3/4
N
1/2
3/4
1/2
1/2
1/2
1/2
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
1/2
N
1/2
1/2
1/2
1/2
N
1/2
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
3/4
3/4
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
N
1/2
N
1/2
1/2
1/2
3/4
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
3/4
1/2
1/2
1/2
3/4
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
1/2
6
471062
65+
Script
Ranking
Drug Name
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
Fluconazole
Cosopt
Colchicine
Fosamax Plus D
Ambien CR
Clindamycin Systemic
4
Ferrous Sulfate
Avandia
Bisoprolol/HCTZ
Clotrimazl/Betamthsn
Glipizide XL
Ntrofrntin Mnohy Mcr
Oxybutynin Chloride
Diltiazem SR
Lotrel
Sotalol
Carisoprodol
Risperdal
Lunesta
Nabumetone
Sulfamethoxazole/Tri
Atenolol Chlorthal
Vigamox
Vesicare
Aggrenox
Fosinopril Sodium
Caduet
4
Benzonatate
Avelox
Requip
Nitrofurantoin Mcroc
Torsemide
Labetalol
Metronidazole Tabs
Phenytoin Sodium Ext
Mirapex
4
Promethazine/Codeine
Bumetanide Non-Inj
Tramadol HCl/APAP
Atacand
Timolol Maleate Oph
Clobetasol
Levothroid
Micardis
Cilostazol
Oxycodone
Metolazone
Estradiol Oral
Thyroid, Armour
Travatan
4
Cheratussin AC
Oxybutynin Chl ER
Coreg CR
Buspirone HCl
Arimidex
Captopril
Zymar
Dicyclomine HCl
4
Cialis
Humulin 70/30
Humulin N
Timolol Maleate GFS
Fluocinonide
Hydroxychloroquine
Zyprexa
Penicillin VK
Lovaza
Flovent HFA
Humalog
Indapamide
Mupirocin
4
Cyanocobalamin
Nifedical XL
Restasis
NovoLog
Nifedipine
Prednisolne Acet Oph
Micardis HCT
Nortriptyline
OxyContin
Enablex
Chlorhexidine Glucon
Generic/Active Ingredient
fluconazole
dorzolamide/timolol
colchicine
alendronate/cholecalciferol
zolpidem
clindamycin
ferrous sulfate
rosiglitazone
bisoprolol/hydrochlorothiazide
clotrimazole/betamethasone
glipizide
nitrofurantoin
oxybutynin chloride
diltiazem
amlodipine/benazepril
sotalol
carisoprodol
risperidone
eszopiclone
nabumetone
sulfamethoxazole/trimethoprim
atenolol/chlorthalidone
moxifloxacin
solifenacin
aspirin/dipyridamole
fosinopril
amlodipine/atorvastatin
benzonatate
moxifloxacin
ropinirole
nitrofurantoin
torsemide
labetolol
metronidazole
phenytoin
pramipexole
promethazine/codeine
bumetanide
tramadol hydrochloride/acetaminophen
candesartan
timolol
clobetasol
levothyroxine
telmisartan
cilostazol
oxycodone
metolazone
estradiol
thyroid
travoprost
guaifenesin
oxybutynin chloride
carvedilol
buspirone
anastrozole
captopril
gatifloxacin
dicyclomine
tadalafil
insulin human
insulin human
timolol
fluocinonide
hydroxychloroquine
olanzipine
penicillin
omega 3 acid
fluticasone
insulin lispro
indapamide
mupirocin
cyanocobalamin
nifedipine
cyclosporine
insulin aspart
nifedipine
prednisolone/sulfacetamide
telmisartan
nortriptyline
oxycodone
darifenacin
chlorhexidine gluconate
Brand/
Generic
G
B
G
B
B
G
G
B
G
G
G
G
G
G
B
G
G
B
B
G
G
G
B
B
B
G
B
G
B
B
G
G
G
G
G
B
G
G
G
B
G
G
B
B
G
G
G
G
B
B
B
G
B
G
B
G
B
G
B
B
B
G
G
G
B
G
B
B
B
G
G
G
G
B
B
G
G
B
G
B
B
G
2nd Highest
Highest
FEHBP with
Estimated
VA
Enrollment Enrollment
Highest
Scripts
Sales
Sales
National
Medicare
Medicare
Enrollment
For 65+
Ranking
Ranking
Formulary
PDP
PDP
Formulary
(in 000s)
(all U.S.)
Formulary Formulary
(65+)2
Status3
Status
Tier Status Tier Status
957
Y
Y
1/2
1/2
455
318
946
Y
Y
1/2
1/2
71
183
943
Y
Y
1/2
1/2
490
736
924
N
Y
1/2
1/2
103
186
908
N
Y
1/2
3/4
78
50
897
Y
Y
1/2
1/2
274
237
638
853
893
Y
N
N
N
886
Y
Y
1/2
1/2
54
88
881
N
Y
1/2
1/2
434
540
870
N
Y
1/2
1/2
305
379
844
N
Y
1/2
1/2
320
500
835
Y
Y
3/4
1/2
352
406
825
Y
Y
1/2
1/2
494
770
798
Y
Y
1/2
1/2
301
531
790
N
Y
1/2
1/2
94
123
782
Y
Y
1/2
1/2
278
530
772
N
N
1/2
1/2
393
209
769
Y
Y
1/2
1/2
43
16
763
N
Y
1/2
3/4
85
60
757
N
Y
1/2
1/2
231
257
751
Y
Y
1/2
1/2
566
564
749
Y
Y
1/2
1/2
541
724
737
Y
Y
1/2
3/4
168
190
736
N
Y
3/4
1/2
93
165
734
Y
Y
1/2
1/2
73
184
731
Y
Y
1/2
1/2
340
536
724
N
Y
3/4
3/4
74
121
355
384
724
N
Y
N
N
721
Y
Y
1/2
3/4
117
103
712
N
Y
1/2
1/2
107
143
711
Y
Y
3/4
1/2
308
455
710
N
Y
1/2
1/2
303
542
705
N
N
1/2
1/2
333
483
705
Y
Y
1/2
1/2
592
555
702
Y
Y
1/2
1/2
286
355
688
Y
Y
1/2
1/2
97
148
503
468
680
N
Y
N
N
674
Y
Y
1/2
1/2
453
785
668
N
N
1/2
1/2
243
298
665
N
Y
3/4
3/4
158
262
654
Y
Y
1/2
1/2
555
972
647
Y
Y
1/2
1/2
288
346
645
Y
Y
1/2
1/2
559
830
642
N
Y
3/4
3/4
179
263
642
N
Y
1/2
1/2
262
509
627
some forms
Y
1/2
1/2
201
115
625
Y
Y
1/2
1/2
335
589
622
Y
Y
1/2
1/2
610
566
617
N
Y
N
1/2
496
572
611
Y
Y
1/2
1/2
148
329
624
644
610
Y
N
N
N
610
N
Y
1/2
1/2
147
252
608
N
Y
3/4
3/4
115
169
608
Y
Y
1/2
1/2
364
338
601
N
Y
1/2
1/2
47
82
595
Y
N
1/2
1/2
635
1030
591
N
Y
1/2
3/4
202
371
591
Y
Y
3/4
1/2
584
713
146
91
572
N
N
N
N
570
Y
Y
1/2
1/2
162
274
559
Y
Y
1/2
1/2
190
272
558
Y
Y
1/2
1/2
354
661
551
Y
Y
1/2
1/2
484
623
551
Y
Y
1/2
1/2
406
456
545
Y
Y
1/2
1/2
31
18
542
Y
Y
1/2
1/2
601
441
542
N
Y
3/4
3/4
124
129
539
N
Y
1/2
1/2
131
87
535
N
Y
1/2
1/2
88
69
534
Y
Y
1/2
1/2
686
1074
532
Y
Y
1/2
1/2
387
365
632
924
529
Y
Y
N
N
529
Y
Y
1/2
1/2
266
435
514
N
Y
1/2
3/4
105
141
509
Y
Y
1/2
1/2
89
72
507
Y
Y
3/4
1/2
252
415
500
Y
Y
1/2
1/2
526
791
496
N
Y
3/4
3/4
196
248
491
Y
Y
1/2
1/2
620
712
490
N
Y
3/4
1/2
39
12
490
N
Y
1/2
3/4
138
250
485
Y
N
1/2
1/2
666
702
7
471062
65+
Script
Ranking
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
Drug Name
Calcitriol
Travatan Z
Proventil HFA
Benazepril/HCTZ
Uroxatral
Jantoven
Phenazopyridine HCl
Isosorbide Dinitrate
Norvasc
4
Docusate Sodium
Pentoxifylline
4
Tussionex
Valtrex
Nystatin Systemic
Acyclovir
Doxepin
Sular
Etodolac
Nadolol
Prednisone Intensol
Theophylline SR
Methocarbamol
Indomethacin
Ketoconazole Topical
Primidone
Astelin
Patanol
Keppra
Tobradex
Cefuroxime Axetil
Diphenoxylate w/Atro
Prochlorperaz Mal
Hyoscyamine
Albuterol Sulf/Iprat
NovoLog Mix 70/30
Ipratropium Br Neb S
Diltiazem
Premarin Vaginal
Catapres-TTS
Byetta
Diltiazem ER
Novolin 70/30
4
Levitra
Chantix
Nasacort AQ
Fortical
Sucralfate
Oxycodone HCL ER
Lactulose
Clarithromycin
Acular LS
Lescol XL
Dexamethasone Oral
Erythromycin Ophth
4
Phenobarbital
Skelaxin
Clarinex
Prandin
Generic/Active Ingredient
calcitriol
travoprost
albuterol
benazepril/hydrochlorothiazide
alfuzosin
warfarin
phenazopyridine
isosorbide dinitrate
amlodipine
docusate
pentoxifylline
hydrocodone/chlorpheniramine
valacyclovir
nystatin
acyclovir
doxepin
nisoldipine
etodolac
nadolol
prednisone
theophylline
methocarbamol
indomethacin
ketoconazole
primidone
azelastine
olopatadine
levetiracetam
dexamethasone/tobramycin
cefuroxime axetil
diphenoxylate/atropine
prochlorperazine
hyoscyamine
albuterol/ipratropium
insulin human
ipratropium
diltiazem
estrogens, conjugated
clonidine
exenatide
diltiazem
insulin human
vardenafil
varenicline
triamcinolone acetonide
calcitonin
sucralfate
oxycodone
lactulose
clarithromycin
ketorolac tromethamine
fluvastatin
dexamethasone
erythromycin
phenobarbital
metaxalone
desloratadine
repaglinide
Brand/
Generic
G
B
B
G
B
B
G
G
B
G
G
B
B
G
G
G
B
G
G
G
G
G
G
G
G
B
B
B
B
G
G
G
G
G
B
G
G
B
B
B
G
B
B
B
B
B
G
G
G
G
B
B
G
G
G
B
B
B
2nd Highest
Highest
FEHBP with
Estimated
VA
Enrollment Enrollment
Highest
Scripts
Sales
Sales
National
Medicare
Medicare
Enrollment
For 65+
Ranking
Ranking
Formulary
PDP
PDP
Formulary
(in 000s)
(all U.S.)
Formulary Formulary
(65+)2
Status3
Status
Tier Status Tier Status
483
Y
Y
1/2
1/2
276
467
483
Y
Y
1/2
1/2
171
364
481
Y
Y
1/2
1/2
295
230
480
N
Y
1/2
1/2
514
684
479
N
Y
3/4
3/4
172
300
478
Y
Y
1/2
1/2
497
880
475
Y
Y
1/2
1/2
754
815
471
Y
Y
1/2
1/2
705
1209
469
Y
Y
3/4
3/4
186
341
834
1166
468
Y
N
N
N
466
N
Y
1/2
1/2
461
818
234
171
466
N
N
N
N
466
Y
Y
1/2
1/2
100
20
465
Y
Y
1/2
1/2
363
410
448
Y
Y
1/2
1/2
510
418
445
Y
Y
1/2
1/2
669
873
444
N
Y
1/2
1/2
206
366
437
some forms
Y
1/2
1/2
405
425
437
N
N
1/2
1/2
516
706
436
Y
Y
1/2
1/2
775
865
430
Y
Y
1/2
1/2
504
789
428
Y
N
3/4
1/2
564
549
425
Y
Y
1/2
1/2
554
646
424
Y
Y
1/2
1/2
438
447
422
Y
Y
1/2
1/2
373
617
418
N
Y
1/2
1/2
211
182
418
N
Y
1/2
1/2
208
187
412
Y
Y
1/2
1/2
64
45
408
Y
Y
1/2
3/4
224
245
405
Y
Y
1/2
1/2
416
404
404
Y
Y
3/4
1/2
650
878
399
Y
Y
1/2
1/2
612
773
396
N
Y
N
1/2
589
663
393
Y
Y
1/2
N
161
295
389
Y
Y
1/2
1/2
102
142
388
Y
Y
1/2
1/2
362
590
387
Y
Y
1/2
1/2
543
866
386
Y
Y
1/2
1/2
207
284
385
Y
Y
1/2
3/4
134
214
383
N
Y
1/2
1/2
101
79
382
Y
Y
1/2
1/2
314
526
381
Y
Y
1/2
1/2
225
375
228
192
378
Y
N
N
N
375
Y
Y
3/4
3/4
181
65
369
N
Y
3/4
3/4
223
154
368
Y
Y
1/2
1/2
246
502
365
Y
Y
1/2
1/2
439
616
364
N
Y
1/2
1/2
87
61
361
Y
Y
1/2
1/2
520
760
360
Y
Y
1/2
1/2
431
352
355
N
Y
1/2
3/4
241
470
355
Y
Y
3/4
1/2
192
356
349
Y
Y
1/2
1/2
683
805
348
Y
Y
1/2
1/2
849
1006
732
746
345
Y
Y
N
N
344
N
N
3/4
3/4
150
99
342
N
Y
3/4
3/4
197
178
336
N
Y
3/4
1/2
152
292
Number of scripts and sales volume data were obtained from the Verispan Vector One National (VONA) database.
VA formulary information was obtained from http://www.pbm.va.gov/NationalFormulary.aspx. The FEHBP with
the highest enrollment is the BCBS Federal Employees Program Basic plan. The BCBS FEP Basic formulary was
obtained from http://www.caremark.com/portal/asset/feprx_807.pdf. According to CMS data, the highest
enrollment Medicare PDP is United AARP MedicareRx Preferred and the second highest enrollment Medicare PDP is
Humana Standard. The United AARP formulary was obtained from
https://www.aarpmedicarerx.com/online_documents/ovation/pdf/pdp/en/2009/ FLPDP3023174_XAPE002.pdf
and the Humana formulary was obtained from http://apps.humana.com/marketing/documents.asp?file=906360.
1
Estimated sales for the 65+ population was based on the average price per prescription for the entire US population
multiplied by the number of prescriptions for the 65+ population for that particular drug.
2
If more than 90% of the script volume for a particular drug was covered by the VA formulary, the entire drug is
labeled as being on the VA formulary. If less than 5% of the script volume for a particular drug was covered by the
VA formulary, the entire drug is labeled as being excluded from the VA formulary. If between 5% and 90% of the
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script volume for a particular drug was covered by the VA formulary, the drug is labeled as having “some forms” on
the VA formulary.
The highlighted drugs are not covered by Part D and were excluded from the analysis: Alprazolam, Aspirin
(enteric-coat), Benzonatate, Cheratussin AC, Cialis, Clonazepam, Cyanocobalamin, Diazepam, Docusate Sodium,
Ferrous Sulfate, Folic Acid, Levitra, Lorazepam, Phenobarbital, Promethazine/Codeine, Temazepam, Tussionex,
Viagra, Vitamin D. The list of Part D excluded drugs was obtained from:
www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/R2PDB.pdf.
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