Department of Health and Human Services 
OFFICE OF 
 
INSPECTOR GENERAL 
 
 
 
 
 
 
 
P D P G
AR  T    LANS  ENERALLY 
 
I D C
NCLUDE  RUGS  OMMONLY 
U D E :
SED BY  UAL  LIGIBLES   
2017 
(I C , S C ) 
NITIAL  APS   MALL  APS
 
Suzanne Murrin  
Deputy Inspector General 
For Evaluation and Inspections 
 
June 2017 
OEI-05-17-00160   
Report in Brief 
June 2017   
OEI-05-17-00160   
 
Why OIG Did This Review   Part D Plans Generally Include Drugs 
This report fulfills for 2017 the annual  Commonly Used by Dual Eligibles:  2017  
reporting mandate from the Patient 
Protection and Affordable Care Act  Key Takeaway 
What OIG Found 
(ACA).  The ACA requires OIG to 
Overall, we found that the rate of Part D  Overall, we found that the rate of 
conduct a study of the extent to which  plan formularies inclusion of the  Part D plan formularies inclusion 
formularies used by Medicare Part D  of the drugs commonly used by 
197 drugs commonly used by dual 
plans include drugs commonly used by  dual eligibles is high, with some 
eligibles is high, with some variation.  On 
full-benefit dual-eligible individuals  variation.  Because some 
average, Part D plan formularies include 
(i.e., individuals who are eligible for  variation exists in formularies 
97 percent of the 197 commonly used 
inclusion of these drugs and in 
both Medicare and full Medicaid 
drugs.  In addition, 70 percent of the 
their application of utilization 
benefits).  These individuals generally 
commonly used drugs are included by all 
management tools to the drugs, 
get drug coverage through Medicare 
Part D plan formularies.  These results are  some dual eligibles may need to 
Part D.  Pursuant to the ACA, OIG must 
largely unchanged from OIGs findings for  make additional efforts to access 
annually issue a report with 
formularies reported in the mandated  the drugs they take.  They could 
recommendations as appropriate.  This  annual report from 2016, as well as our  appeal prescription drug coverage 
is the seventh report OIG has produced  decisions, switch prescription 
findings from 2011 through 2015. 
to meet this mandate.  drugs, or switch Part D plans.  
We also found that the percentage of  Because these scenarios require 
How OIG Did This Review 
drugs to which plan formularies applied  additional effort by dual eligibles, 
For this report, we determined whether  utilization management tools remained  they may result in administrative 
the 369 unique formularies used by the  the same from 2016 to 2017.  On  barriers to accessing certain 
3,014 Part D plans operating in 2017  average, formularies applied utilization  prescription drugs. 
cover the 200 drugs most commonly 
management tools to 28 percent of the 
used by dual eligibles.  We also 
unique drugs we reviewed in 2017, the same percentage as in 
determined the extent to which plan 
2016. 
formularies applied utilization 
What OIG Concludes   
management tools to those commonly 
Inclusion rates for the 197 drugs commonly used by dual 
used drugs.  To create the list of the 
eligibles are largely unchanged compared with the inclusion 
200 drugs most commonly used by dual 
rates listed in our previous reports.  Part D formularies include 
eligibles, we used data from the 2012 
roughly the same percentage of these commonly used drugs in 
Medicare Current Beneficiary Survey
2017 as they did in 2016.   
the most recent data available at the 
time of our study.  Of the top 200  As mandated by the ACA, OIG will continue to monitor and 
drugs, 197 are eligible for Part D  produce annual reports on the extent to which Part D plan 
prescription drug coverage, 1 is  formularies cover drugs that dual eligibles commonly use.  In 
excluded from coverage, and 1 is no  addition, OIG will continue to monitor Part D plan formularies 
longer prescribed in the form taken by  application of utilization management tools to these drugs.  OIG 
beneficiaries.  One additional drug is  has no recommendations at this time. 
eligible for Part D prescription drug 
 
coverage.  However, we did not include 
 
it in our analysis because we could not 
 
confidently project the use of this drug 
to the entire dual-eligible population. 
   
TABLE OF CONTENTS 
 
Objectives ....................................................................................................1 
Background ..................................................................................................1 
Methodology ................................................................................................6 
Findings......................................................................................................12 
Part D Plan Formularies Include Between 88 and 100 Percent of 
the Drugs Commonly Used by Dual Eligibles ...............................12 
Seventy Percent of the Drugs Commonly Used by Dual Eligibles 
Are Included in All Part D Plan Formularies .................................14 
The Percentage of Commonly Used Drugs To Which Plan 
Formularies Applied Utilization Management Tools Stayed the 
Same Between 2016 and 2017 .......................................................17 
Conclusion .................................................................................................19 
Appendixes ................................................................................................20 
A:  Section 3313 of the Patient Protection and Affordable Care 
Act of 2010 ....................................................................................20 
B:  Commonly Used Drugs and Rates of Inclusion by 
Formularies ....................................................................................21 
C:  Two Drugs Commonly Used by Dual Eligibles and Not 
Covered Under Part D ....................................................................27 
D:  Formulary Inclusion of Stand-Alone Prescription Drug Plans 
and Medicare Advantage Prescription Drug Plans, by Region ......28 
Acknowledgments......................................................................................30 
 
   
   
   
OBJECTIVES 
1.  To determine the extent to which Part D plan formularies cover the 
drugs commonly used by dual eligibles. 
2.  To determine the extent to which Part D plan formularies applied 
utilization management tools to the drugs commonly used by dual 
eligibles. 
BACKGROUND  
Pursuant to the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA), comprehensive prescription drug 
coverage under Medicare Part D is available to all Medicare beneficiaries 
through prescription drug plans (PDPs) and Medicare Advantage 
prescription drug plans (MA-PDs), hereinafter referred to collectively as 
Part D plans.1  
For beneficiaries who are eligible for both Medicare and Medicaid 
(hereinafter referred to as dual eligibles), Medicare covers Part D plan 
premiums, deductibles, and other cost-sharing up to a determined 
premium benchmark that varies by region.  If dual eligibles enroll in 
Part D plans with premiums higher than the regional benchmark, they are 
responsible for paying the premium amounts above that benchmark. 
To control costs and ensure the safe use of drugs, Part D plans are allowed 
to establish formularies from which they may omit drugs from prescription 
coverage and are allowed to control drug utilization through utilization 
management tools.2  These tools include prior authorization, quantity 
limits, and step therapy.3   
The Centers for Medicare & Medicaid Services (CMS) annually reviews 
Part D plan formularies to ensure that they include a range of drugs in a 
broad distribution of therapeutic categories or classes.  CMS also assesses 
the utilization management tools present in each formulary. 
   
 
1 MMA, P.L. No. 108-173  101, Social Security Act,  1860D-1(a). 
2 A formulary is a list of drugs covered by a Part D plan.  Part D plans can exclude drugs 
from their formularies and can control utilization for formulary-included drugs within 
certain parameters.  Social Security Act  1860D-4(b) and (c). 
3 Prior authorizationoften required for very expensive drugsrequires that physicians 
obtain approval from Part D plans to prescribe a specific drug.  Quantity limits are 
intended to ensure that beneficiaries receive the proper dose and recommended duration 
of drug therapy.  Step therapy is the practice of beginning drug therapy for a medical 
condition with the drug therapy that is the most cost-effective or safest and progressing if 
necessary to more costly or risky drug therapy. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  1 
     
   
The Medicare Prescription Drug Benefit 
Beginning in 2006, the MMA made comprehensive prescription drug 
coverage under Medicare Part D available to all Medicare beneficiaries.4  
Medicare beneficiaries generally have the option to enroll in a PDP and 
receive all other Medicare benefits on a fee-for-service basis, or to enroll 
in an MA-PD and receive all of their Medicare benefits, including 
prescription drug coverage, through managed care.5  As of January 2017, 
approximately 42.3 million of the 57.7 million Medicare beneficiaries 
were enrolled in a Part D plan. 
Part D plans are administered by private companiesknown as plan 
sponsorsthat contract with CMS to offer prescription drug coverage in 
one or more PDP or MA-PD regions.  CMS has designated 34 PDP 
regions and 26 MA-PD regions.  In 2017, plan sponsors offer 
3,014 unique Part D plans, with many plan sponsors offering multiple 
Part D plans.  
Dual Eligibles Under Medicare Part D  
Approximately 11.4 million Medicare beneficiaries are dual eligibles.  For 
about 8.2 million dual eligibles, referred to as full-benefit dual eligibles, 
Medicaid provides full Medicaid benefits, including Medicaid-covered 
services, and may also assist beneficiaries with premiums and cost-sharing 
for Medicare fee-for-service or Medicare managed care.6  For other dual 
eligibles, Medicaid does not provide Medicaid-covered services, but 
provides assistance with beneficiaries Medicare premiums or 
cost-sharing, depending on their level of income and assets. 
Dual eligibles are a particularly vulnerable population.  Overall, most dual 
eligibles have very low incomes:  86 percent have annual incomes below 
150 percent of the Federal poverty level, compared with 22 percent of all 
other Medicare beneficiaries.  Additionally, dual eligibles are in worse 
health than the average Medicare beneficiaryhalf are in fair or poor 
health, more than twice the rate of others in Medicare.7  Because of their 
self-reported health needs, dual eligibles may use more prescription drugs 
and health care services in general than other Medicare beneficiaries. 
Until December 31, 2005, dual eligibles received outpatient prescription 
drug benefits through Medicaid.  In January 2006, Medicare began 
 
4 MMA, P.L. No. 108-173  101, Social Security Act,  1860D-1(a). 
5 CMS, PDBM, ch. 1,  10.1. 
6 Kaiser Family Foundation, Medicares Role for Dual Eligible Beneficiaries.  Accessed 
at http://www.kff.org/medicare/upload/8138-02.pdf on April 13, 2017. 
7 Ibid. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  2 
     
   
covering outpatient prescription drugs for dual eligibles through Part D 
plans.8 
Medicare covers Part D plan premiums for dual eligibles up to a set 
benchmark.  The benchmark is a statutorily defined amount that is based 
on the average premium amounts for Part D plans for each region.9, 10  If 
dual eligibles enroll in Part D plans with premiums higher than the 
regional benchmark, they are responsible for paying the premium amounts 
above that benchmark.11 
Dual eligibles assignment to Part D plans.  When individuals become 
eligible for both Medicare and Medicaid, CMS randomly assigns those 
individuals to PDPs unless they have elected a specific Part D plan or have 
opted out of Part D prescription drug coverage.12  The PDPs to which 
CMS assigns dual eligibles must meet certain requirements, such as 
having a premium at or below the regional benchmark amount and 
offering basic prescription drug coverage (or equivalent).13  Basic 
prescription drug coverage is defined in terms of benefit structure (initial 
coverage, coverage gap, and catastrophic coverage) and costs (initial 
deductible and coinsurance). 
Some dual eligibles may be randomly assigned to PDPs that do not cover 
the specific drugs they use.  However, unlike the general Medicare 
population, dual eligibles can switch Part D plans at any time to find plans 
that cover the prescription drugs they require.14  When dual eligibles 
change plans, their prescription drug coverage under the new Part D plan 
becomes effective at the beginning of the following month. 
CMS annually reassigns some dual eligibles to new PDPs if their current 
PDPs will have premiums above the regional benchmark premium for the 
following year.15  For dual eligibles who were randomly assigned to their 
 
8 MMA, P.L. No. 108-173  101, Social Security Act,  1860D-1(a). 
9 Social Security Act,  1860D-14(b); 42 CFR  423.780(b)(2)(i 
10 Dual eligibles residing in territories are not eligible to receive cost-sharing assistance 
from Medicare.  With this being the case, there are no benchmarks for Part D plans 
offered in the territories.  Social Security Act,  1860D-14(a)(3)(F). 
11 The ACA established a de minimis premium policy, whereby a Part D plan may elect 
to charge dual eligibles the benchmark premium amount if the Part D plans basic 
premium exceeds the regional benchmark by a de minimis amount.  Patient Protection 
and Affordable Care Act (ACA), P.L. No. 111-148  3303, Social Security Act, 
 1860D-14(a)(5).  For 2017, CMS set the de minimis amount at $2 above the regional 
benchmark. 
12 CMS, PDBM, ch. 3,  40.1.4. 
13 Ibid. 
14 Ibid.,  30.3.2.  In general, Medicare beneficiaries can switch Part D plans only once a 
year during a defined enrollment period. 
15 Ibid.,  40.1.5. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  3 
     
   
current PDPs, CMS chooses new PDPs that will have premiums at or 
below the regional benchmark premium.16  For dual eligibles who elected 
their current Part D plans, CMS notifies them that their plans will have 
premiums above the regional benchmark premium.  For 2017, CMS 
reported reassigning approximately 277,000 Medicare beneficiaries, 
including but not exclusively dual eligibles, because of premium 
increases. 
Part D Prescription Drug Coverage 
Under Part D, plans can establish formularies from which they may 
exclude drugs and control drug utilization within certain parameters.  
These parameters are intended to balance Medicare beneficiaries needs 
for adequate prescription drug coverage with Part D plan sponsors needs 
to contain costs.  Generally, a formulary must include at least two drugs in 
each therapeutic category or class.17, 18  In addition, Part D plans must 
include Part D-covered drugs in certain categories and classes.19  
Part D plans may also control drug utilization by applying utilization 
management tools.  These tools include requiring prior authorization to 
obtain drugs that are on plan formularies, establishing quantity limits, and 
requiring step therapy.  Utilization management tools can help Part D 
plans and the Part D program limit the cost of prescription drug coverage 
by placing restrictions on the use of certain drugs. 
In addition to these drug coverage decisions that Part D plans make 
regarding individual formularies, certain categories of drugs are excluded 
from Medicare Part D prescription drug coverage as mandated by the 
MMA.20  For example, prescription vitamins, prescription mineral 
products, and nonprescription drugs are excluded from Part D prescription 
drug coverage.21    
Until 2013, barbiturates and benzodiazepines were excluded from Part D 
prescription drug coverage.  However, the ACA reversed this exclusion, 
 
16 CMS, PDBM,  40.1.5. 
17 Ibid., ch. 6,  30.2.1. 
18 Therapeutic categories or classes classify drugs according to their most common 
intended uses.  For example, cardiovascular agents compose a therapeutic class intended 
to affect the rate or intensity of cardiac contraction, blood vessel diameter, or blood 
volume. 
19 Social Security Act,  1860D-4(b)(3)(G). 
20 MMA, P.L. No. 108-173  101, Social Security Act,  1860D-2(e). 
21 Social Security Act  1860D-2(e)(2), 1927(d)(2). 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  4 
     
   
removing these two drug types from the list of drug classes ineligible for 
such coverage.22, 23 
CMS Efforts To Ensure Prescription Drug Coverage 
Formulary Review.  CMS annually reviews Part D plan formularies to 
ensure that they include a range of drugs in a broad distribution of 
therapeutic categories or classes, as well as all drugs in specified 
therapeutic categories or classes.24  During this review, CMS analyzes 
formularies coverage of the drug classes most commonly prescribed for 
the Medicare population.  CMS intends for Part D plans to cover the most 
widely used medications, or therapeutically alternative medications (i.e., 
drugs from the same therapeutic category or class), for the most common 
conditions.  CMS uses Part D prescription drug data to identify the most 
commonly prescribed classes of drugs.25  
CMS also assesses each formularys utilization management tools to 
ensure consistency with current industry standards and with standards that 
are widely used with drugs for the elderly and people with 
disabilities.26, 27, 28 
Exceptions and appeals process.  CMS has implemented an exceptions 
and appeals process whereby beneficiaries can request coverage of 
nonformulary drugs or an exception to a utilization management tool that 
applies to a formulary drug.  When a Part D plan receives a prescribers 
statement supporting an exception request, the plan must notify the 
beneficiary of its determination within 72 hours or, for expedited requests, 
within 24 hours.29  If the beneficiarys plan makes an adverse 
determination, the beneficiary has the right to appeal.30  If the plan 
continues to deny the beneficiarys request, the beneficiary has additional 
appeal rights and may continue to appeal until those rights are exhausted.  
Alternatively, the beneficiary can work with his or her prescriber to 
 
22 ACA, P.L. No. 111-148  2502, Social Security Act,  1927(d). 
23 CMS, Transition to Part D Coverage of Benzodiazepines and Barbiturates Beginning 
in 2013.  Accessed at http://www.cms.gov/Medicare/Prescription-Drug-
Coverage/PrescriptionDrugCovContra/Downloads/BenzoandBarbituratesin2013.pdf on 
April 13, 2017. 
24 CMS, PDBM, ch. 6,  30.2.7. 
25 Ibid. 
26 Ibid.,  30.2.2. 
27 Ibid.,  30.2.7. 
28 CMS looks to appropriate guidelines from expert organizations such as the National 
Committee for Quality Assurance, the Academy of Managed Care Pharmacy, and the 
National Association of Insurance Commissioners. 
29 CMS, PDBM, ch. 18,  30.1 and 30.2. 
30 Ibid.,  60.1. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  5 
     
   
determine whether there is an appropriate therapeutically equivalent 
alternative drug on the plans formulary. 
Transitioning new enrollees to Part D.  CMS requires that Part D plans 
establish a transition process for new enrollees (including dual eligibles) 
who are transitioning to their respective Part D plans either from different 
Part D plans or from other prescription drug coverage.  During Medicare 
beneficiaries first 90 days under a new Part D plan, the new plan must 
provide one temporary refill of a prescription when beneficiaries request 
either a drug that is not in the plans formulary or a drug that requires prior 
authorization or step therapy under the formularys utilization 
management tools.31  The temporary fill accommodates beneficiaries 
immediate drug needs the first time they attempt to fill a prescription.  The 
transition period also allows beneficiaries time to work with their 
prescribing physicians to obtain prescriptions for therapeutically 
alternative drugs or to request formulary exceptions from Part D plans. 
Related OIG Work 
In 2006, OIG published a report assessing the extent to which PDP 
formularies included drugs commonly used by dual eligibles under 
Medicaid.  The study found that PDP formularies included between 76 and 
100 percent of the 178 drugs commonly used by dual eligibles under 
Medicaid prior to the implementation of Part D.  Approximately half of 
the 178 commonly used drugs were covered by all formularies.32  
In 2011, OIG issued the first annual mandated report examining dual 
eligibles access to drugs under Medicare Part D.33  We have released an 
annual mandated report each year since then.34, 35, 36, 37, 38  The current report 
is the seventh report released. 
 
31 CMS, PDBM, ch. 6,  30.4.4. 
32 OIG, Dual Eligibles Transition:  Part D Formularies Inclusion of Commonly Used 
Drugs, OEI-05-06-00090, January 2006. 
33 OIG, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2011, 
OEI-05-10-00390, April 2011. 
34 OIG, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2012, 
OEI-05-12-00060, June 2012. 
35 OIG, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2013, 
OEI-15-13-00090, June 2013. 
36 OIG, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2014, 
OEI-05-14-00170, June 2014. 
37 OIG, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2015, 
OEI-05-15-00120, June 2015. 
38 OIG, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2016, 
OEI-05-16-00090, June 2016. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  6 
     
   
METHODOLOGY 
Scope 
As mandated in the ACA, this study assessed the extent to which drugs 
commonly used by dual eligibles are included by Part D plan formularies.  
To make this assessment, we evaluated formularies for Part D plans 
operating in 2017.  As part of our assessment, we included dual eligibles 
enrollment data from March 2017, the most recent enrollment data 
available from CMS at the time of our study.  We also compared the 
results of our 2017 study with those of our 2016 study.39 
The ACA did not define which drugs commonly used by dual eligibles we 
should review.  We defined drugs commonly used by dual eligibles as the 
200 drugs with the highest utilization by dual eligibles as reported in the 
Medicare Current Beneficiary Survey (MCBS)i.e., the 2012 MCBS.  
We used the MCBS because it contains drugs that dual eligibles received 
through multiple sources (e.g., Part D, Medicaid, and the Department of 
Veterans Affairs) and, as such, it provides a comprehensive picture of drug 
utilization.  Of the 200 highest utilization drugs that we identified using 
the MCBS, 197 are eligible for coverage under Part D.  In this report, we 
refer to these 197 Part D-eligible high utilization drugs as commonly 
used drugs. 
The list of 200 drugs with the highest utilization by dual eligibles 
referenced in this 2017 report is the same list of drugs referenced in the 
2016 report. 
For each study, OIG went beyond the ACAs mandate by reviewing drug 
coverage for all dual eligibles under Medicare Part D, rather than only for 
full-benefit dual eligibles.  With the data available for this study, we could 
not confidently identify and segregate full-benefit dual eligiblesand thus 
the drugs they usedfrom the total population of dual eligibles. 
We also went beyond the ACAs mandate in the 2013, 2014, 2015, 2016, 
and 2017 reports by examining the utilization management tools that 
Part D plan formularies apply to the drugs commonly used by dual 
eligibles.  These tools may affect dual eligibles access even in cases 
where formularies include the commonly used drugs.  Analyzing the 
extent to which Part D plan formularies apply these tools to drugs 
commonly used by dual eligibles allows us to provide a comprehensive 
picture of Part D plan formularies coverage of, and dual eligibles access 
to, those drugs. 
 
39 OIG, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2016, 
OEI-05-16-00090, June 2016. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  7 
     
   
Data Sources 
MCBS.  We used the 2012 MCBS Cost and Use data to create a list of the 
200 drugs with the highest utilization by dual eligibles.  The MCBS Cost 
and Use data contain information on hospitals, physicians, and 
prescription drug costs and utilization.  The 2012 MCBS Cost and Use 
data were the most recent data available at the time of our study and were 
also used for this analysis in the 2016 report.  Historically, the list of the 
200 drugs with the highest utilization by dual eligibles has remained 
largely unchanged between one year and the next.  The list for 2016 
overlapped by 91 percent with the list for 2015, which in turn overlapped 
by 93 percent with the list for 2014.40 
The MCBS is a continuous, multipurpose survey that CMS conducts of 
a representative national sample of the Medicare population, including 
dual eligibles.  Sampled Medicare beneficiaries were interviewed three 
times per year and asked what drugs they were taking and whether they 
had started taking any new drugs since the previous interview.  The MCBS 
also includes Part D prescription drug events for surveyed Medicare 
beneficiaries.  In 2012, the MCBS surveyed 11,299 Medicare 
beneficiaries, of whom 2,244 were dual eligibles who had used 
prescription drugs during the year (out of 2,484 dual-eligible survey 
respondents). 
First DataBank National Drug Data File.  We used the April 2017 First 
DataBank National Drug Data File to identify the drug product 
information for the 200 drugs with the highest utilization by dual eligibles.  
The National Drug Data File is a database that contains informationsuch 
as drug name, therapeutic category or class, and the unique combination of 
active ingredientsfor each drug as defined by a National Drug Code 
(NDC).41 
Part D plan data.  In March 2017, we collected from CMS the formulary 
data and the plan data for Part D plans operating in 2017.  The formulary 
data includes Part D plans formularies and utilization management tools 
for plans operating in 2017.  In 2017, there are 369 unique formularies 
offered by 3,014 Part D plans.  The plan data provides information such as 
the State in which a Part D plan is offered, whether the Part D plan is 
a PDP or an MA-PD, and whether the Part D plan premium is below the 
regional benchmark.   
 
40 In 2015, we used the 2011 data and in 2014, we used the 2010 data. 
41 An NDC is a three-part universal identifier that specifies the drug manufacturers 
name, the drug form and strength, and the package size. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  8 
     
   
We also collected 2017 enrollment data for Part D plans.  These data 
provide the number of dual eligibles enrolled in each Part D plan as of 
March 2017. 
Determining the Most Commonly Used Drugs 
To determine the drugs most commonly used by dual eligibles, we took 
the following steps: 
1.  We created a list of all drugs reported by dual eligibles surveyed in 
the 2012 MCBS.  We excluded respondents from territories 
because they are not eligible to receive cost-sharing assistance 
under Part D.  The MCBS listed 167,848 drug events for 
2,244 dual eligibles who did not reside in territories.42  
2.  We collapsed this list to a list of drugs based on their active 
ingredients, using the Ingredient List Identifier located in First 
DataBanks National Drug Data File.  For example, 
a multiple-source drug such as fluoxetine hydrochloride (the active 
ingredient for the brand-name drug Prozac) has only one entry on 
our list, covering all strengths of both the brand-name drug Prozac 
and the available generic versions of fluoxetine hydrochloride.  
From this point forward, unless otherwise stated, we will use the 
term drug to refer to any drug in the same Ingredient List 
Identifier category, and the term unique drug to refer to an NDC 
corresponding to a drug, as a given drug can have multiple NDCs.  
This process left 167,848 drug events associated with 868 drugs. 
3.  We ranked the 868 drugs by frequency of utilization, weighting the 
drug-event information from MCBS by sample weight. 
4.  We selected the 200 drugs with the highest utilization by dual 
eligibles.  For a full list of the top 200 drugs, see Appendix B. 
5.  We removed all drugs not covered under Part D.  Of the 200 drugs 
with the highest utilization, 197 are eligible under Part D.  One fell 
into a drug category excluded under Part D, and one is no longer 
prescribed in the form taken by beneficiaries surveyed in the 
2012 MCBS.  One additional drug is eligible for Part D 
prescription drug coverage.  However, we did not include it in our 
analysis because we could not confidently project the use of this 
drug to the entire dual-eligible population.  For details on the 
two drugs excluded under Part D, see Appendix C. 
 
42 For the purposes of this report, a drug event is an MCBS survey response indicating 
that the responding beneficiary took a specific drug at least once in 2012.  For example, 
1 MCBS survey respondent reported taking rosuvastatin calcium (Crestor) 12 times in 
2012.  We counted this beneficiary/drug combination as 12 drug events. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  9 
     
   
Formulary Analysis 
We analyzed the 369 unique Part D plan formularies to determine their 
rates of inclusion of the 197 drugs commonly used by dual eligibles.  We 
counted a drug as included in a Part D plans formulary if the formulary 
included the active ingredient.  When a drug included multiple ingredients 
that could be dispensed separately and combined by the patient to the 
same effect as the combined drug, we treated the drug as included if the 
ingredients were included in the formulary either separately or in 
combination. 
Low rates of inclusion by formularies.  We determined which of the 
197 commonly used drugs had low rates of inclusion by formularies by 
counting how many of the 369 formularies covered each drug.  We 
considered a drug to have a low rate of inclusion if it was included by 
75 percent or less of formularies.  For such drugs, we counted the number 
of drugs (if any) that each formulary covered in the same therapeutic 
category or class.   
We conducted this analysis to ensure that dual eligibles have access to 
therapeutically similar drugs.  We also conducted additional research to 
identify potential reasons why some of the 197 commonly used drugs 
were included by 75 percent or less of formularies. 
Utilization management tools.  We determined the extent to which Part D 
plans apply utilization management tools to the 197 drugs that we 
reviewed.  The tools that we reviewed are prior authorization, quantity 
limits, and step therapy. 
To determine the extent to which Part D plan formularies applied 
utilization management tools to the 197 commonly used drugs, we 
conducted an analysis of the NDCs that correspond to the commonly used 
drugs.  Part D plan formularies do not apply utilization management tools 
at the active ingredient level.  Rather, Part D plan formularies apply 
utilization management tools at a more specific level that identifies 
whether a drug is brand-name or generic and its dosage form, strength, and 
route of administration, irrespective of package size.  To conduct this 
analysis, we determined the NDCs (unique drugs) associated with each of 
the 197 commonly used drugs that are on each Part D formulary.  We then 
calculated the percentage of unique drugs to which each Part D plan 
formulary applies utilization management tools. 
Enrollment Analysis 
We weighted the formulary analysis by dual-eligible enrollment and 
weighted the analysis of utilization management tools by both 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  10 
     
   
dual-eligible enrollment and Medicare enrollment.  To do this, we applied 
enrollment data from March 2017 to Part D plans available in 2017. 
Data Limitations   
We did not assess individual dual eligibles prescription drug use or 
whether individual dual eligibles are enrolled in Part D plans that include 
the specific drugs that each individual uses.  Because we relied on 
a sample of dual eligibles responding to the MCBS to develop our list of 
commonly used drugs, a particular dual eligible might not use any of the 
drugs on our list.  However, the drugs most commonly used by 
dual-eligible MCBS survey participants in 2012 account for 88 percent of 
all prescriptions dispensed to the dual-eligible respondents in the 
2012 MCBS. 
Standards 
This study was conducted in accordance with the Quality Standards for 
Inspection and Evaluation issued by the Council of the Inspectors General 
on Integrity and Efficiency. 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  11 
     
   
FINDINGS 
Part D Plan Formularies Include Between 88 and 
100 Percent of the Drugs Commonly Used by Dual 
Eligibles 
On average, Part D plan formularies include 97 percent of the drugs 
commonly used by dual eligibles.  Of the 369 unique formularies used by 
Part D plans in 2017, 14 formularies include 100 percent of the commonly 
used drugs.  At the other end of the inclusion range, four formularies 
include 88 percent of the commonly used drugs.  Exhibit 1 provides 
a breakdown of the formularies inclusion rates for the drugs most 
commonly used by dual eligibles.  CMS generally requires Part D plan 
formularies to include at least two drugsrather than all drugsin each 
therapeutic category or class.  Therefore, Part D plan formularies may still 
meet CMSs formulary requirements even if they do not include all of the 
drugs we identified as commonly used by dual eligibles.
Exhibit 1:  Nearly two-thirds of Part D plan formularies cover at least 
97 percent of the drugs commonly used by dual eligibles. 
Source:  OIG analysis of formulary inclusion of drugs commonly used by dual eligibles, 2017. 
Part D plan formularies rate of inclusion of the drugs commonly used by 
dual eligibles in 2017 is similar to that of 2016.  The average rate of 
inclusion increased slightly between 2016 and 2017, from 96 percent to 
97 percent.  The range of inclusion rates in 2016 and 2017 are the same
88 to 100 percent of the drugs commonly used by dual eligibles. 
Nationally, PDP and MA-PD formularies have similar rates of inclusion of 
the drugs commonly used by dual eligibles, averaging 95 percent and 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  12 
     
   
97 percent, respectively.  For PDP and MA-PD formularies, the rates of 
inclusion ranged from 88 to 100 percent.  Eleven formularies3 percent 
of the 369 unique formularies used by Part D plans in 2017are offered 
by both PDPs and MA-PDs. 
Regionally, all dual eligibles have the choice of a Part D plan that includes 
at least 98 percent of the commonly used drugs.  Every PDP region has 
a plan that includes at least 99 percent of the commonly used drugs, and 
every MA-PD region has a plan that includes at least 98 percent of these 
drugs.  Appendix D provides a breakdown of formularies rates of 
inclusion of the drugs by PDP and MA-PD region. 
On average, formularies for Part D plans with premiums below 
the regional benchmark include 96 percent of the drugs 
commonly used by dual eligibles 
The percentage of drugs included by Part D plans with premiums below 
the regional benchmark is important because dual eligibles are 
automatically enrolled in, or annually reassigned to, such plans.  For drugs 
commonly used by dual eligibles, formularies for such plans have rates of 
inclusion that range from 88 percent to 100 percent.  Approximately 
85 percent of dual eligibles are enrolled in Part D plans with premiums 
below the regional benchmark. 
Most dual eligibles are enrolled in Part D plans that include at 
least 90 percent of the drugs commonly used by dual eligibles 
Of the approximately 9.9 million dual eligibles enrolled in Part D plans, 
approximately 96 percent are enrolled in Part D plans that use formularies 
that include at least 90 percent of the commonly used drugs.  Four percent 
of dual eligibles are enrolled in Part D plans that use formularies that 
include less than 90 percent of these drugs.  Exhibit 2 provides 
a breakdown of dual eligibles enrollment in Part D plans by the rates at 
which the plans formularies include the commonly used drugs. 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  13 
     
   
Exhibit 2:  Enrollment of Dual Eligibles in Part D Plans, by Formularies 
Inclusion of Commonly Used Drugs 
Part D Plans With Formularies That  Number of Dual  Percentage of Dual 
Include:  Eligibles Enrolled  Eligibles Enrolled 
100% of commonly used drugs            249,598   3% 
95% to 99% of commonly used drugs           5,340,291   54% 
90% to 94% of commonly used drugs           3,891,989   39% 
85% to 89% of commonly used drugs  405,474   4% 
     Total               9,887,352   100% 
Source:  OIG analysis of formulary inclusion of drugs commonly used by dual eligibles and dual eligibles 
enrollment, 2017. 
The percentage of dual eligibles enrolled in Part D plans that include at 
least 90 percent of the drugs commonly used by dual eligibles decreased 
from nearly 100 percent in 2016 to 96 percent in 2017. 
Seventy Percent of the Drugs Commonly Used by Dual 
Eligibles Are Included in All Part D Plan Formularies 
Because most of the commonly used drugs are included in a large 
percentage of formularies, dual eligibles can be confident that regardless 
of the Part D plan in which they are enrolled, the plans formulary will 
include many of these drugs.  By drug, inclusion in formularies ranges 
from 46 percent to 100 percent.  At one end of the range, there is a drug 
that is included in 46 percent of Part D plan formularies, and at the other 
end, 138 drugs are included in all plan formularies.  The average rate of 
inclusion in formularies is 97 percent.  Exhibit 3 shows the rates at which 
formularies include the 197 drugs.  Appendix B lists the 197 drugs and the 
rates at which formularies include them. 
Exhibit 3:  Formularies Rates of Inclusion of Commonly Used Drugs 
Percentage of the 197 Commonly 
Percentage of the 369 Formularies  Used Drugs Included in 
Formularies 
70% 
100% 
(138 drugs) 
22% 
85% to 99% 
(43 drugs) 
3% 
76% to 84% 
(6 drugs) 
5% 
46% to 75% 
(10 drugs) 
100% 
    Total 
(197 drugs) 
      . 
Source:  OIG analysis of State Medicaid claims data, 2007
The rates at which formularies include the drugs commonly used by dual 
eligibles in 2017 are similar to those in 2016.  The percentage of 
commonly used drugs included in all formularies increased slightly 
between 2016 and 2017, from 68 percent to 70 percent. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  14 
     
   
Part D plan formularies include certain drugs less frequently 
than others 
Of the commonly used drugs, 5 percent (10 drugs) are included by 
75 percent or less of Part D plan formularies.  Exhibit 4 provides the 
percentage of formularies covering each of these 10 drugs. 
The drugs that make up this group include both brand-name and generic 
drugs and are used to treat a variety of primary indications.  Five of the 
10 drugs are brand-name drugs, which are typically more costly than 
generic drugs.  As for the primary indications, 3 of the 10 drugs are used 
for diabetes therapy, 2 are muscle relaxants, 2 are used for gastrointestinal 
conditions, and the remaining drugs treat a variety of conditions. 
Exhibit 4:  Drugs Included by 75 Percent or Less of Part D Plan Formularies 
Rate of 
Generic Name of Drug  Primary Indication(s)  Inclusion by 
Formularies 
Risedronate sodium  Osteoporosis, Paget's disease of bone  75% 
Insulin aspart  74% 
Diabetes 
Budesonide/formoterol fumarate  Inflammation, bronchodilator  73% 
Solifenacin succinate  Overactive bladder, incontinence  73% 
Esomeprazole magnesium  Dyspepsia, peptic ulcer disease, gastroesophageal reflux  63% 
disease, Zollinger-Ellison syndrome 
Methocarbamol  60% 
Musculoskeletal pain 
Insulin lispro  59% 
Diabetes 
Dexlansoprazole  51% 
Gastroesophageal reflux disease 
Glyburide  48% 
Diabetes 
Carisoprodol  Musculoskeletal pain  46% 
Source:  OIG analysis of formularies inclusion of drugs commonly used by dual eligibles, 2017. 
The drugs in the shaded rows also had low rates of inclusion by formularies in 2016. 
 
Although Part D formularies frequently omit these 10 drugs, they all cover 
other drugs in the same respective therapeutic classes.  For each of these 
10 drugs, 100 percent of formularies cover at least 1 drug in the same 
therapeutic class that is also on the list of 197 drugs commonly used by 
dual eligibles. 
The number of drugs included by 75 percent or less of formularies 
increased from 9 in 2016 to 10 in 2017.  There are seven drugs with low 
inclusion rates in 2017 that were also on the list of commonly used drugs 
with low inclusion rates in our 2016 report; we note these seven drugs 
above in Exhibit 4.  Five of these seven drugs were also on the list of 
drugs with low inclusion rates in our 2015 report. 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  15 
     
   
There are multiple potential reasons why a commonly used drug might be 
included by 75 percent or less of formularies: 
  Two of these drugscarisoprodol and methocarbamolare on 
CMSs list of Part D medications that are high-risk for the 
elderly.43 
  The two drugs above and a third drugglyburideare listed by 
the American Geriatrics Society as being potentially inappropriate 
for older adults.44 
  The American Geriatrics Society also cautions against certain uses 
of proton pump inhibitor drugs (PPIs) and drugs with strong 
anticholinergic properties.  Dexlansoprazole and esomeprazole 
magnesium are PPIs, and solifenacin succinate has strong 
anticholinergic properties.45 
If a particular drug has a low rate of inclusion by formularies, a dual 
eligible may need to obtain a nonformulary drug.  There are several means 
by which dual eligibles can obtain a nonformulary drug, all of which 
require them to take additional action.  If dual eligibles wish to obtain 
therapeutically equivalent alternative drugs that are included by their 
plans formularies, they would need to get new prescriptions from their 
doctors.  Dual eligibles may also go through an appeals process to obtain 
coverage of nonformulary drugs by submitting statements of medical 
necessity from their physicians.46  Finally, dual eligibles may switch to 
Part D plans with formularies that include their drugs, with the new 
coverage becoming effective the following month.47 
   
 
43 This listUse of High-Risk Medications in the Elderly:  High-Risk Medications 
is part of the Healthcare Effectiveness and Information Set national drug code measures 
published by the National Committee for Quality Assurance.  A drug that is listed as 
being high risk for the elderly is one that has a high risk of serious side effects in that 
population.  CMS uses its prescription data and this medication list to calculate the 
percentage of Medicare beneficiaries who received at least one high-risk medication in 
the past year.  CMS publishes this percentage and other measures of Part D patient safety 
so that Medicare beneficiaries can make informed decisions in choosing Part D plans for 
their prescription drug coverage.  National Committee on Quality Assurance, HEDIS 
2012 NDC List.  Accessed at http://www.cms.gov/Medicare/Prescription-Drug-Coverage/ 
PrescriptionDrugCovContra/Downloads/MemoPatientSafetyMeasures_071610.pdf on 
April 13, 2017. 
44 The American Geriatrics Society, American Geriatrics Society 2015 Updated Beers 
Criteria for Potentially Inappropriate Medication Use in Older Adults, 2015. 
45 Ibid. 
46 CMS, PDBM, ch. 18,  30.2.2. 
47 Ibid., ch. 3,  30.3.2. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  16 
     
   
The Percentage of Commonly Used Drugs To Which 
Plan Formularies Applied Utilization Management 
Tools Stayed the Same Between 2016 and 2017 
For the unique drugs that compose the list of commonly used drugs, the 
percentage to which Part D plan formularies applied utilization 
management tools remained unchanged, at an average of 28 percent in 
2016 and 2017.  There was not much of a difference between plans with 
premiums below the regional benchmarks and those with premiums above 
those benchmarks; formularies for the two groups of plans used utilization 
management tools for 25 percent and 29 percent, respectively, of their 
drugs.  See Exhibit 5 for a breakdown of the percentage of unique drugs to 
which Part D plan formularies apply utilization management tools in 2016 
and 2017. 
Exhibit 5:  Part D Plan Formularies Application of Utilization Management Tools to 
Commonly Used Drugs, 2016 and 2017 
Percentage of Unique Drugs  Number of  Number of 
Percentage of  Percentage of 
to Which Utilization  2016 Part D  2017 Part D 
2016 Part D Plan  2017 Part D Plan 
Management Tools Are  Plan  Plan 
Formularies  Formularies 
Applied  Formularies  Formularies 
Greater than 40%  22  6%  60  16% 
30% to 39%  189  50%  85  23% 
20% to 29%  59  16%  140  38% 
10% to 19%  74  20%  66  18% 
Less than 10%  30  8%  18  5% 
     Totals  374  100%  369  100% 
Source:  OIG analysis of formulary inclusion of drugs commonly used by dual eligibles, 2017. 
Although utilization management tools can restrict beneficiaries access to 
drugs, they are important tools for managing costs in Medicare and 
ensuring appropriate utilization of drugs.  For example, in 2013, CMS set 
forth expectations for reviews of opioid overutilization to help ensure that 
opioids are appropriately prescribed and used.  As a result, formularies 
application of utilization management controls to oxycodone HCl/ 
acetaminophen drugs increased by 30 percent in 2013.48 
The percentage of drugs for which formularies applied the utilization 
management tools of quantity limits, prior authorization, or step therapy49 
stayed the same from 2016 to 2017.  Formularies applied quantity limits to 
24 percent of drugs, required prior authorization for 4 percent of drugs, 
and required step therapy for 1 percent of unique drugs. 
 
48 CMS, Supplemental Guidance Related to Improving Drug Utilization Review Controls 
in Part D, September 6, 2012.  Accessed at https://www.cms.gov/Medicare/Prescription-
Drug-Coverage/PrescriptionDrugCovContra/Downloads/HPMSSupplementalGuidance 
Related-toImprovingDURcontrols.pdf on April 13, 2017. 
49 See footnote 3 for explanations of quantity limits, prior authorization, and step therapy. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  17 
     
   
The rate at which plan formularies apply specific utilization management 
tools varies widely.  In 2017, some formularies applied utilization 
management tools to none of the unique drugs, whereas at the other end of 
the range, some applied tools to 44 percent of the unique drugs.  More 
specifically, formularies apply quantity limits to between 0 and 42 percent 
of unique drugs, require prior authorization for between 0 and 14 percent, 
and require step therapy for between 0 and 8 percent. 
Looking at enrollment across plans provides a slightly different picture 
than looking only at plans themselves.  On average, plan formularies in 
2017 apply utilization management tools to 28 percent of unique drugs.  
However, dual eligibles tend to be enrolled in plans with formularies that 
apply these tools at a slightly higher rate.  In 2017, the median plan 
weighted by dual-eligible enrollment applies such tools to 29 percent of 
unique drugs; in 2016, the figure was 32 percent.  Similarly, the median 
plan weighted by overall Medicare enrollment applies these tools to 
30 percent of unique drugs in 2017; in 2016, the figure was 31 percent. 
Both dual eligibles and Medicare beneficiaries overall tend to be enrolled 
in plans with formularies that apply utilization management tools to 
between 20 and 39 percent of unique drugs.  In 2017, 87 percent of dual 
eligibles and 79 percent of Medicare beneficiaries overall were enrolled in 
plans with formularies in this range.  Exhibit 6 shows enrollment in Part D 
plans by dual eligibles and Medicare beneficiaries, as broken down by the 
percentages at which the plans formularies apply utilization management 
tools. 
Exhibit 6:  Beneficiary Enrollment in Part D Plans by Application of 
Utilization Management Tools to Commonly Used Drugs, 2016 and 2017 
Percentage of Unique  Percentage  Percentage  Percentage  Percentage 
Drugs to Which Plan  of Dual  of Medicare  of Dual  of Medicare 
Formularies Apply  Eligibles  Beneficiaries  Eligibles  Beneficiaries 
Utilization Management  Enrolled,  Enrolled,  Enrolled,  Enrolled, 
Tools   2016  2016  2017  2017 
Greater than 40%  1%  1%  8%  13% 
30% to 39%  79%  72%  37%  39% 
20% to 29%  14%  18%  50%  40% 
10% to 19%  3%  5%  3%  4% 
Less than 10%  2%  4%  2%  3% 
     Totals  100%*  100%  100%  100%* 
Source:  OIG analysis of formulary inclusion of drugs commonly used by dual eligibles, 2017. 
* Percentages do not add to 100 percent because of rounding. 
 
 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  18 
     
   
CONCLUSION 
When establishing formularies and applying utilization management tools, 
Part D plans need to balance Medicare beneficiaries needs for adequate 
prescription drug coverage with the need to contain costs for plan sponsors 
and for the Part D program.  By law, Part D plan formularies do not have 
to include every available drug.  Rather, to meet CMSs formulary 
requirements, they must include at least two drugs in each therapeutic 
category or class.  For example, for each of the 10 drugs that this report 
identifies as being included by 75 percent or less of Part D plan 
formularies, all Part D plan formularies cover at least 1 therapeutically 
equivalent alternative drug.  Part D plan formularies may also institute 
utilization management tools to ensure appropriate utilization as well as to 
control costs. 
For the drugs commonly used by dual eligibles, we found that the rate of 
formulary inclusion is high with some variation.  On average, Part D plan 
formularies include 97 percent of the commonly used drugs.  Part D plan 
formularies inclusion of the commonly used drugs ranges from 88 percent 
to 100 percent.  Formulary inclusion rates are similar for PDPs and 
MA-PDs.  Further, formularies for Part D plans with premiums below the 
regional benchmark include the commonly used drugs at a rate similar to 
that of Part D plan formularies overall. 
Inclusion rates for the 197 drugs commonly used by dual eligibles are 
largely unchanged compared with those from OIGs 2016 report.  Part D 
plan formularies include roughly the same percentage of these commonly 
used drugs in 2017 as they did in 2016.  Enrollment in plans that cover at 
least 90 percent of unique drugs decreased, with 96 percent of dual 
eligibles enrolled in such plans in 2017 compared to nearly 100 percent of 
dual eligibles in 2016. 
Because some variation exists in Part D plan formularies inclusion of the 
commonly used drugs and in their application of utilization management 
tools to these drugs, some dual eligibles may need to make additional 
efforts to access the drugs they take.  They could appeal prescription drug 
coverage decisions, switch prescription drugs, or switch Part D plans.  
Because these scenarios require additional effort by dual eligibles, they 
may result in administrative barriers to accessing certain prescription 
drugs. 
As mandated by the ACA, OIG will continue to monitor and produce 
annual reports on the extent to which Part D plan formularies cover drugs 
that dual eligibles commonly use.  In addition, OIG will continue to 
monitor Part D plan formularies application of utilization management 
tools to these drugs.  OIG has no recommendations at this time.   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  19 
     
   
APPENDIX A 
Section 3313 of the Patient Protection and Affordable Care Act 
of 2010 
SEC. 3313.  OFFICE OF THE INSPECTOR GENERAL STUDIES AND 
REPORTS. 
(a)  STUDY AND ANNUAL REPORT ON PART D FORMULARIES 
INCLUSION OF DRUGS COMMONLY USED BY DUAL 
ELIGIBLES. 
(1)  STUDY.The Inspector General of the Department of Health and 
Human Services shall conduct a study of the extent to which formularies 
used by prescription drug plans and MA-PD plans under Part D include 
drugs commonly used by full benefit dual eligible individuals (as defined 
in section 1935(c)(6) of the Social Security Act (42 U.S.C.  
1396u5(c)(6)). 
(2)  ANNUAL REPORTS.Not later than July 1 of each year (beginning 
with 2011), the Inspector General shall submit to Congress a report on the 
study conducted under paragraph (1), together with such recommendations 
as the Inspector General determines appropriate. 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  20 
     
   
APPENDIX B 
Commonly Used Drugs and Rates of Inclusion by Formularies
The 200 Drugs With the Highest Utilization by Dual Eligibles  
*Sample is from the 2012 MCBS.  Projections and confidence intervals are derived from its survey methodology. 
Number of 
Projected  Percentage of 
Sample  95-Percent Confidence  Formularies 
Generic Name  Drug  Formularies 
Size*  Interval*  Including 
Events*  Including Drug 
Drug 
Simvastatin  4,085  20,275,845  18,246,78822,304,903  369  100% 
Lisinopril  4,146  20,105,037  17,883,00522,327,069  369  100% 
Omeprazole  4,277  17,651,028  15,907,56419,394,492  369  100% 
Levothyroxine Sodium  3,875  16,391,504  14,506,69918,276,310  369  100% 
Hydrocodone/Acetaminophen  4,335  15,724,258  13,700,63317,747,884  369  100% 
Furosemide  3,594  15,682,269  13,969,19817,395,341  369  100% 
Metformin HCl  3,053  15,402,973  13,342,09317,463,852  369  100% 
Amlodipine Besylate  3,084  14,334,829  12,552,77516,116,883  369  100% 
Potassium Chloride  2,535  9,847,651  8,425,38111,269,921  369  100% 
Gabapentin  2,195  9,659,579  7,744,86711,574,290  369  100% 
Atorvastatin Calcium  1,892  9,469,703  8,032,97810,906,428  369  100% 
Metoprolol Tartrate  2,161  9,465,474  8,198,82710,732,121  369  100% 
Hydrochlorothiazide  1,684  8,538,793  7,204,2279,873,358  369  100% 
Warfarin Sodium  2,143  8,176,792  6,782,6359,570,949  369  100% 
Albuterol Sulfate  1,809  8,051,430  6,601,0899,501,772  369  100% 
Esomeprazole Magnesium  1,623  7,345,547  5,669,7489,021,345  233  63% 
Tramadol HCl  1,814  7,033,265  5,908,2068,158,324  369  100% 
Citalopram Hydrobromide  1,743  7,028,557  5,999,8408,057,274  369  100% 
Clopidogrel Bisulfate  1,420  6,884,688  5,592,0488,177,329  369  100% 
Atenolol  1,341  6,622,365  5,452,7387,791,992  369  100% 
Zolpidem Tartrate  1,479  6,486,938  5,054,3257,919,552  357  97% 
Carvedilol  1,354  6,189,667  5,070,6877,308,647  369  100% 
Insulin  1,299  5,924,792  4,861,2446,988,340  362  98% 
Glargine,hum.Rec.Anlog 
Promethazine HCl  2,023  5,868,471  4,226,0807,510,861  367  99% 
Glipizide  1,064  5,847,097  4,635,2107,058,983  369  100% 
Fluticasone/Salmeterol  1,111  5,800,120  4,224,9837,375,257  350  95% 
Oxycodone HCl/  1,474  5,676,415  4,586,5696,766,261  369  100% 
Acetaminophen 
Metoprolol Succinate  1,120  5,665,210  4,616,3246,714,096  368  100% 
Ranitidine HCl  1,409  5,482,639  4,145,8626,819,416  369  100% 
Losartan Potassium  1,153  5,482,241  4,424,4766,540,005  369  100% 
Trazodone HCl  1,285  5,420,884  4,236,8376,604,931  369  100% 
Clobetasol Propionate  1,232  5,343,963  3,259,8677,428,059  305  83% 
Sertraline HCl  1,329  5,328,104  4,285,1126,371,097  369  100% 
continued on next page 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  21 
     
   
The 200 Drugs With the Highest Utilization by Dual Eligibles, continued 
Number of 
Projected  Percentage of 
Sample  95-Percent Confidence  Formularies 
Generic Name  Drug  Formularies 
Size*  Interval*  Including 
Events*  Including Drug 
Drug 
Alendronate Sodium  1,134  5,059,020  4,027,9786,090,062  369  100% 
Valsartan  999  4,988,907  3,709,0416,268,773  365  99% 
Quetiapine Fumarate  1,580  4,695,543  3,580,8225,810,265  369  100% 
Pravastatin Sodium  1,055  4,497,382  3,599,8135,394,952  369  100% 
Fluticasone Propionate  1,031  4,475,369  3,782,7975,167,942  369  100% 
Montelukast Sodium  983  4,241,912  3,276,6545,207,171  369  100% 
Prednisone  987  4,140,130  3,299,8914,980,370  369  100% 
Rosuvastatin Calcium  862  4,079,698  3,143,9925,015,404  345  93% 
Donepezil HCl  1,067  3,945,615  3,220,9464,670,284  369  100% 
Risperidone  1,320  3,931,788  3,128,0464,735,529  369  100% 
Bupropion HCl  880  3,854,353  2,640,7275,067,980  369  100% 
Isosorbide Mononitrate  797  3,805,846  3,135,3064,476,386  369  100% 
Clonidine HCl  765  3,747,550  2,494,4395,000,661  369  100% 
Tamsulosin HCl  741  3,702,932  2,870,6554,535,209  369  100% 
Lovastatin  760  3,603,172  2,680,2554,526,090  368  100% 
Aripiprazole  915  3,588,383  2,471,1054,705,661  369  100% 
Cyclobenzaprine HCl  884  3,576,109  2,862,7224,289,496  366  99% 
Duloxetine HCl  829  3,455,834  2,612,0264,299,643  369  100% 
Pantoprazole Sodium  745  3,437,474  2,677,1594,197,789  369  100% 
Allopurinol  713  3,403,401  2,647,1984,159,603  369  100% 
Escitalopram Oxalate  881  3,387,426  2,551,3904,223,461  369  100% 
Ibuprofen  953  3,311,577  2,684,3843,938,770  369  100% 
Fluoxetine HCl  793  3,256,783  2,506,9274,006,640  369  100% 
Alprazolam  852  3,243,748  2,306,1614,181,334  322  87% 
Oxycodone HCl  923  3,211,833  2,344,8564,078,811  369  100% 
Diltiazem HCl  804  3,112,978  2,356,1103,869,845  369  100% 
Glimepiride  596  3,102,504  2,097,4294,107,579  369  100% 
Azithromycin  826  2,990,930  2,651,7763,330,084  369  100% 
Divalproex Sodium  1,147  2,956,347  2,371,6993,540,994  369  100% 
Memantine HCl  820  2,946,246  2,305,4193,587,073  369  100% 
Nystatin  778  2,877,573  1,728,1674,026,980  369  100% 
Pregabalin  620  2,874,390  1,945,8833,802,897  369  100% 
Olanzapine  826  2,743,691  1,746,9753,740,406  369  100% 
Famotidine  598  2,741,416  2,001,6033,481,230  365  99% 
Amitriptyline HCl  648  2,732,645  2,025,5663,439,723  369  100% 
Sitagliptin Phosphate  563  2,731,020  1,929,9373,532,103  358  97% 
Tiotropium Bromide  561  2,700,930  2,048,6313,353,230  301  82% 
continued on next page 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  22 
     
   
The 200 Drugs With the Highest Utilization by Dual Eligibles, continued 
Number of 
Projected  Percentage of 
Sample  95-Percent Confidence  Formularies 
Generic Name  Drug  Formularies 
Size*  Interval*  Including 
Events*  Including Drug 
Drug 
Meloxicam  641  2,699,758  2,079,8603,319,656  369  100% 
Ketoconazole  778  2,678,585  1,642,0813,715,089  369  100% 
Mirtazapine  693  2,629,860  1,932,9773,326,744  369  100% 
Nifedipine  467  2,620,445  1,841,0873,399,804  360  98% 
Lisinopril/Hydrochlorothiazide  561  2,602,432  2,034,1293,170,735  369  100% 
Lamotrigine  812  2,568,810  1,524,9013,612,719  369  100% 
Levetiracetam  774  2,542,145  1,772,6303,311,661  369  100% 
Clonazepam  696  2,474,602  1,754,4673,194,736  369  100% 
Enalapril Maleate  551  2,442,608  1,834,2603,050,956  369  100% 
Triamterene/ 
Hydrochlorothiazide  484  2,409,224  1,777,6593,040,789  369  100% 
Paroxetine HCl  608  2,399,150  1,706,2983,092,003  369  100% 
Celecoxib  482  2,386,463  1,634,4293,138,497  335  91% 
Benztropine Mesylate  796  2,344,725  1,666,4263,023,025  368  100% 
Carbamazepine  711  2,291,674  1,547,2403,036,107  369  100% 
Ciprofloxacin HCl  561  2,201,817  1,879,7692,523,865  369  100% 
Spironolactone  530  2,167,379  1,706,0242,628,734  369  100% 
Nitroglycerin  489  2,159,899  1,556,8442,762,953  369  100% 
Diclofenac Sodium  459  2,071,649  1,535,7082,607,591  369  100% 
Valsartan/ 
Hydrochlorothiazide  411  2,043,602  1,418,4122,668,792  362  98% 
Digoxin  563  2,017,627  1,397,3472,637,908  369  100% 
Latanoprost  451  1,941,504  1,429,8722,453,136  369  100% 
Topiramate  676  1,919,140  1,225,7772,612,502  369  100% 
Morphine Sulfate  482  1,917,895  1,323,9032,511,887  369  100% 
Fluocinonide  517  1,914,945  984,5792,845,310  368  100% 
Polyethylene Glycol 3350  563  1,911,548  1,456,5162,366,580  369  100% 
Sulfamethoxazole/ 
Trimethoprim  575  1,882,925  1,565,5742,200,276  369  100% 
Lorazepam  478  1,872,334  1,385,5922,359,076  369  100% 
Ipratropium/Albuterol Sulfate  475  1,863,411  1,265,0892,461,734  362  98% 
Carbidopa/Levodopa  469  1,847,813  1,150,9582,544,668  369  100% 
Fenofibrate Nanocrystallized  393  1,802,940  1,311,2342,294,646  348  94% 
Glyburide  333  1,800,905  1,292,0572,309,754  178  48% 
Levofloxacin  450  1,776,547  1,439,4012,113,694  369  100% 
Oxybutynin Chloride  465  1,772,254  1,130,9862,413,522  369  100% 
Venlafaxine HCl  565  1,769,289  1,293,0932,245,485  369  100% 
Verapamil HCl  386  1,768,870  1,232,5682,305,172  369  100% 
Pioglitazone HCl  350  1,765,584  1,267,9582,263,210  369  100% 
continued on next page 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  23 
     
   
The 200 Drugs With the Highest Utilization by Dual Eligibles, continued 
Number of 
Projected  Percentage of 
Sample  95-Percent Confidence  Formularies 
Generic Name  Drug  Formularies 
Size*  Interval*  Including 
Events*  Including Drug 
Drug 
Naproxen  481  1,712,919  1,305,6372,120,202  369  100% 
Triamcinolone Acetonide  401  1,709,516  1,194,1752,224,857  369  100% 
Cephalexin  461  1,708,905  1,354,5462,063,263  369  100% 
Insulin Aspart  438  1,697,897  1,236,2822,159,511  274  74% 
Meclizine HCl  354  1,694,107  1,166,4382,221,776  368  100% 
Cinacalcet HCl  273  1,686,744  228,7513,144,737  369  100% 
Benazepril HCl  314  1,662,487  1,061,7792,263,195  368  100% 
Amoxicillin  449  1,645,349  1,440,4301,850,269  369  100% 
Ezetimibe  315  1,630,531  1,137,3722,123,691  369  100% 
Hydralazine HCl  352  1,626,562  1,040,3542,212,770  369  100% 
Losartan/Hydrochlorothiazide  323  1,616,723  1,126,2092,107,237  369  100% 
Methocarbamol  332  1,604,238  957,8522,250,624  222  60% 
Carisoprodol  468  1,569,542  1,069,9162,069,169  168  46% 
Lansoprazole  300  1,517,331  937,7322,096,931  289  78% 
Lidocaine  392  1,497,702  1,062,2291,933,176  369  100% 
Baclofen  432  1,496,342  901,7592,090,925  369  100% 
Propranolol HCl  441  1,466,579  989,9031,943,256  369  100% 
Tizanidine HCl  465  1,402,405  922,1521,882,657  369  100% 
Buspirone HCl  345  1,392,828  771,7202,013,936  369  100% 
Lactulose  352  1,376,489  858,0831,894,894  369  100% 
Brimonidine Tartrate  270  1,364,643  814,0361,915,250  369  100% 
Omega-3 Acid Ethyl Esters  337  1,340,484  863,7541,817,215  323  88% 
Methadone HCl  233  1,334,501  668,8122,000,191  368  100% 
Metoclopramide HCl  272  1,311,286  790,7711,831,801  369  100% 
Ropinirole HCl  318  1,304,881  795,6811,814,080  369  100% 
Phenytoin Sodium Extended  414  1,299,826  893,2471,706,406  369  100% 
Budesonide/ 
Formoterol Fumarate  297  1,282,394  897,1951,667,593  270  73% 
Timolol Maleate  251  1,278,484  801,8321,755,136  369  100% 
Hydrocortisone  279  1,276,518  768,3571,784,678  369  100% 
Travoprost  325  1,223,842  898,8381,548,847  327  89% 
Olopatadine HCl  288  1,210,924  776,9191,644,928  353  96% 
Hydroxyzine HCl  296  1,208,115  813,7931,602,437  355  96% 
Bimatoprost  206  1,206,009  747,3061,664,713  352  95% 
Insulin Detemir  325  1,203,894  807,2161,600,572  303  82% 
Ziprasidone HCl  331  1,183,365  639,9471,726,783  369  100% 
Doxazosin Mesylate  253  1,166,572  705,7081,627,436  369  100% 
Insulin Lispro  243  1,165,251  612,8421,717,661  217  59% 
continued on next page 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  24 
     
   
The 200 Drugs With the Highest Utilization by Dual Eligibles, continued 
Number of 
Projected  Percentage of 
Sample  95-Percent Confidence  Formularies 
Generic Name  Drug  Formularies 
Size*  Interval*  Including 
Events*  Including Drug 
Drug 
Diazepam  336  1,163,773  805,7881,521,758  369  100% 
Pramipexole Di-HCl  269  1,163,159  716,8591,609,460  369  100% 
Dexlansoprazole  255  1,154,307  605,9891,702,624  189  51% 
Acetaminophen With Codeine  324  1,146,119  835,5141,456,724  369  100% 
Finasteride  193  1,142,207  645,8011,638,614  369  100% 
Metronidazole  277  1,082,251  740,2941,424,207  369  100% 
Estrogens, Conjugated  207  1,062,210  680,5811,443,839  305  83% 
Ramipril  216  1,044,656  618,6601,470,651  366  99% 
Mometasone Furoate  273  1,041,955  738,0621,345,847  368  100% 
Doxycycline Hyclate  306  1,039,974  803,0521,276,896  369  100% 
Gemfibrozil  317  1,002,452  655,3981,349,505  369  100% 
Insulin Regular, Human  321  997,047  448,3811,545,713  369  100% 
Clozapine  377  996,800  256,7961,736,805  369  100% 
Amoxicillin/Potassium Clav  296  992,326  798,7421,185,910  369  100% 
Fentanyl  283  950,958  630,4401,271,475  369  100% 
Fenofibrate  200  947,241  530,0411,364,441  368  100% 
Terazosin HCl  196  944,375  600,1071,288,642  369  100% 
Quinapril HCl  176  941,788  521,2521,362,324  363  98% 
Amlodipine Besylate/ 
Benazepril  210  938,298  638,2821,238,313  352  95% 
Tolterodine Tartrate  218  934,963  602,6581,267,269  355  96% 
Insulin Nph Hum/Reg Insulin 
Hm  223  926,025  503,3221,348,729  369  100% 
Fluconazole  268  906,521  631,4791,181,562  369  100% 
Sucralfate  252  899,714  608,7361,190,692  369  100% 
Niacin  249  884,662  476,2451,293,079  364  99% 
Colchicine  183  874,820  496,0961,253,544  369  100% 
Solifenacin Succinate  189  861,786  578,3761,145,197  268  73% 
Megestrol Acetate  226  860,045  569,0491,151,041  369  100% 
Ciclopirox Olamine  190  846,025  291,4801,400,570  353  96% 
Calcitriol  181  844,443  510,5741,178,312  369  100% 
Hydroxychloroquine Sulfate  227  843,974  546,0861,141,862  369  100% 
Dicyclomine HCl  258  835,905  510,7201,161,090  369  100% 
Sevelamer Carbonate  181  834,843  473,1551,196,532  365  99% 
Dorzolamide HCl/ 
Timolol Maleate  183  820,248  535,8271,104,669  363  98% 
Raloxifene HCl  170  817,458  404,8261,230,090  369  100% 
Ergocalciferol (Vitamin D)  238  815,762  577,4441,054,081  0  0%** 
2
Dutasteride  175  812,367  421,1631,203,571  345  93% 
**See Appendix C. 
continued on next page 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  25 
     
   
The 200 Drugs With the Highest Utilization by Dual Eligibles, continued 
Number of 
Projected  Percentage of 
Sample  95-Percent Confidence  Formularies 
Generic Name  Drug  Formularies 
Size*  Interval*  Including 
Events*  Including Drug 
Drug 
Cyclosporine  206  811,780  542,0871,081,473  369  100% 
Ipratropium Bromide  212  809,312  479,3061,139,318  369  100% 
Methylprednisolone  208  804,664  635,543973,784  369  100% 
Prednisolone Acetate  186  793,727  589,346998,109  363  98% 
Clotrimazole/Betamethasone 
Dip  215  793,462  607,917979,006  289  78% 
Estradiol  152  785,815  436,4141,135,216  369  100% 
Primidone  200  780,692  193,8581,367,527  369  100% 
Torsemide  197  780,054  485,1861,074,923  361  98% 
Nitrofurantoin Monohyd/ 
M-Cryst  192  773,126  516,9751,029,278  344  93% 
Albuterol  176  770,589  478,2251,062,953  0  0%** 
Sumatriptan Succinate  146  Excluded  Excluded  Excluded  Excluded 
Risedronate Sodium  147  763,979  295,1761,232,781  275  75% 
0.9% Sodium Chloride  216  754,836  155,7201,353,952  369  100% 
Cilostazol  202  751,130  399,9431,102,317  369  100% 
Amiodarone HCl  149  750,614  391,6671,109,561  369  100% 
Chlorthalidone  150  735,530  370,4801,100,580  366  99% 
Doxepin HCl  202  724,154  404,2931,044,015  369  100% 
Mupirocin  204  697,884  520,300875,469  369  100% 
Ondansetron HCl  183  663,507  421,480905,535  369  100% 
Metolazone  127  657,608  251,5431,063,674  361  98% 
Clonidine  114  654,668  234,6161,074,720  369  100% 
Source:  OIG analysis of drugs commonly used by dual eligibles, 2017.   
**See Appendix C. 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  26 
     
   
APPENDIX C 
Two Drugs Commonly Used by Dual Eligibles and Not Covered 
Under Part D
Generic Name  Reason Excluded Under Part D 
No longer prescribed without 
Albuterol* 
sulfate 
Ergocalciferol (vitamin D)*  Vitamin or mineral product 
2
Source:  OIG analysis of formulary inclusion of drugs commonly used by dual eligibles, 2017. 
*These drugs were also on the 2016 reports list of drugs commonly used by dual eligibles 
and not covered under Part D. 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  27 
     
   
APPENDIX D 
Formulary Inclusion of Stand-Alone Prescription Drug Plans* 
and Medicare Advantage Prescription Drug Plans**, by Region
Exhibit D-1:  PDP Formularies Inclusion of Commonly Used Drugs, by PDP Region 
PDP  Number of  Average Rate of Drug  Maximum 
State(s)  Minimum Rate 
Region  PDPs  Inclusion by Formularies  Rate 
1  Maine, New Hampshire  21  95%  89%  100% 
Connecticut, Massachusetts, 
2 
Rhode Island, Vermont  19  95%  89%  99% 
3  New York  17  95%  89%  100% 
4  New Jersey  19  95%  89%  99% 
Delaware, the District of 
5 
Columbia, Maryland  18  95%  89%  100% 
6  Pennsylvania, West Virginia  22  96%  89%  100% 
7  Virginia  21  95%  89%  100% 
8  North Carolina  20  95%  89%  100% 
9  South Carolina  19  95%  89%  99% 
10  Georgia  21  95%  89%  100% 
11  Florida  18  95%  89%  99% 
12  Alabama, Tennessee  22  96%  89%  100% 
13  Michigan  21  95%  89%  100% 
14  Ohio  20  95%  89%  99% 
15  Indiana, Kentucky  21  95%  89%  100% 
16  Wisconsin  22  95%  89%  99% 
17  Illinois  21  95%  88%  100% 
18  Missouri  21  95%  89%  100% 
19  Arkansas  20  95%  89%  100% 
20  Mississippi  17  95%  89%  99% 
21  Louisiana  18  95%  89%  100% 
22  Texas  21  95%  88%  100% 
23  Oklahoma  20  95%  88%  99% 
24  Kansas  20  95%  89%  99% 
Iowa, Minnesota, Montana, 
25  Nebraska, North Dakota, 
South Dakota, Wyoming  20  95%  89%  100% 
26  New Mexico  21  95%  88%  100% 
27  Colorado  21  95%  89%  100% 
28  Arizona  20  95%  89%  100% 
29  Nevada  21  95%  89%  99% 
30  Oregon, Washington  19  95%  89%  99% 
31  Idaho, Utah  22  95%  89%  100% 
32  California  22  95%  89%  99% 
33  Hawaii  17  95%  89%  99% 
34  Alaska  16  95%  89%  99% 
Source:  OIG analysis of formularies inclusion of drugs commonly used by dual eligibles, 2017. 
 
*PDP. 
**MA-PD. 
   
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  28 
     
   
Exhibit D-2:  MA-PD Formularies Inclusion of Commonly Used Drugs, by MA-PD Region 
Average Rate of 
MA-PD  Number of 
State(s)  Drug Inclusion by  Minimum Rate  Maximum Rate 
Region***   MA-PDs 
Formularies 
1  Maine, New Hampshire  45  97%  95%  99% 
Connecticut, Massachusetts, 
2 
Rhode Island, Vermont  93  97%  94%  99% 
3  New York  185  97%  94%  100% 
4  New Jersey  38  96%  88%  98% 
Delaware, the District of Columbia, 
5 
Maryland  28  98%  96%  100% 
6  Pennsylvania, West Virginia  148  98%  94%  100% 
7  North Carolina, Virginia  112  97%  89%  100% 
8  Georgia, South Carolina  89  98%  94%  100% 
9  Florida  243  98%  90%  100% 
10  Alabama, Tennessee  76  97%  95%  99% 
11  Michigan  66  98%  94%  99% 
12  Ohio  117  97%  93%  99% 
13  Indiana, Kentucky  100  97%  94%  99% 
14  Illinois, Wisconsin  140  97%  92%  99% 
15  Arkansas, Missouri  69  97%  88%  99% 
16  Louisiana, Mississippi  59  98%  95%  100% 
17  Texas  142  97%  93%  100% 
18  Kansas, Oklahoma  53  97%  95%  99% 
Iowa, Minnesota, Montana, Nebraska, 
19  North Dakota, South Dakota, 
Wyoming  79  97%  92%  99% 
20  Colorado, New Mexico  59  98%  96%  100% 
21  Arizona  59  97%  94%  100% 
22  Nevada  31  97%  94%  99% 
23  Idaho, Oregon, Utah, Washington  168  97%  93%  100% 
24  California  259  97%  93%  100% 
25  Hawaii  18  98%  95%  100% 
Source:  OIG analysis of formularies inclusion of drugs commonly used by dual eligibles, 2017. 
***Region 26, which covers Alaska, had no MA-PDs available for 2017. 
 
 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  29 
     
   
ACKNOWLEDGMENTS 
This report was prepared under the direction of Thomas Komaniecki, 
Regional Inspector General for Evaluation and Inspections in the Chicago 
regional office.  
Hilary Slover served as the team leader for this study.  Other Office of 
Evaluation and Inspections staff from the Chicago regional office who 
conducted the study include Megan Shade.  Central office staff who 
provided support include Kevin Farber, Meghan Kearns, Christine Moritz, 
and David Tawes. 
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles:  2017 (OEI-05-17-00160)  30 
     
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