Table 2. Medicare Part D Beneficiary Spending for Drugs on CVS Caremark and Express Scripts Formulary Exclusion Lists and Savings Through Generic Substitution, 2012-2015, Stratified by Qualification for Low-Income Subsidy.
| Parameter | Year | ||||
|---|---|---|---|---|---|
| 2012 | 2013 | 2014a | 2015a | Total | |
| Low-Income Subsidy Beneficiaries | |||||
| Prescriptions filled by beneficiaries, No. | 121 350 | 401 689 | 458 875 (19 425) | 381 470 (24 022) | 1 363 384 |
| Beneficiary out-of-pocket costs on excluded drugs, $ | 1 791 559 | 7 558 744 | 7 682 408 (287 130) | 6 828 236 (330 743) | 23 860 948 |
| Projected beneficiary out-of-pocket costs if generics had been substituted, $ | 592 161 | 2 732 674 | 3 218 884 (96 921) | 2 532 001 (123 113) | 9 075 720 |
| Potential beneficiary savings if generics had been substituted, $ | 1 199 398 | 4 826 070 | 4 463 524 (190 209) | 4 296 235 (207 630) | 14 785 227 |
| Potential beneficiary savings if generics had been substituted, per prescription, $ | 9.88 | 12.01 | 9.73 (9.79) | 11.26 (8.64) | 10.84 |
| Non–Low-Income Subsidy Beneficiaries | |||||
| Prescriptions filled by beneficiaries, No. | 187 178 | 736 786 | 890 504 (43 459) | 751 478 (39 558) | 2 565 946 |
| Beneficiary out-of-pocket costs on excluded drugs, $ | 44 405 639 | 164 246 734 | 212 705 832 (9 072 822) | 202 679 587 (9 238 821) | 624 037 793 |
| Projected beneficiary out-of-pocket costs if generics had been substituted, $ | 7 793 885 | 44 714 178 | 51 604 031 (1 836 601) | 40 812 174 (1 520 732) | 144 924 268 |
| Potential beneficiary savings if generics had been substituted, $ | 36 611 754 | 119 532 557 | 161 101 800 (7 236 220) | 161 867 413 (7 718 090) | 479 113 524 |
| Potential beneficiary savings if generics had been substituted, per prescription, $ | 195.60 | 162.24 | 180.91 (166.51) | 215.40 (195.11) | 186.72 |
| All Beneficiaries | |||||
| Prescriptions filled by beneficiaries, No. | 308 528 | 1 138 475 | 1 349 379 (62 884) | 1 132 948 (63 580) | 3 929 330 |
| Beneficiary out-of-pocket costs on excluded drugs, $ | 46 197 198 | 171 805 479 | 220 388 239 (9 359 951) | 209 507 824 (9 569 564) | 647 898 740 |
| Projected beneficiary out-of-pocket costs if generics had been substituted, $ | 8 386 046 | 47 446 852 | 54 822 915 (1 933 522) | 43 344 175 (1 643 845) | 153 999 988 |
| Potential beneficiary savings if generics had been substituted, $ | 37 811 152 | 124 358 627 | 165 565 324 (7 426 429) | 166 163 648 (7 925 719) | 493 898 752 |
| Potential beneficiary savings if generics had been substituted, per prescription, $ | 122.55 | 109.23 | 122.70 (118.10) | 146.66 (124.66) | 125.70 |
a
Numbers in parentheses represent the value only among the drugs excluded by both CVS Caremark and Express Scripts in a given year.