Medicare.gov Tutorial - Select Preferred Pharmacy or Pharmacies

In the past, the Medicare Plan Finder allowed us to skip Step 3 of 4 and typically we clicked on "I don't want to add pharmacies at this time" or continue or whatever button is available to move on the next step. We were not being lazy. We skipped this step because we figured that you would almost always have a nearby network pharmacy since most national Medicare Part D prescription drug plans have over 50,000 participating pharmacies in their network and the list of pharmacies continues to grow in almost every Pharmacy Network. But now, we usually choose two different local pharmacies representing national pharmacy chains to see if there is any variation in retail drug price (and there usually is).

There are several reasons why it is important for you to select one or two pharmacies where you will be using your Medicare Part D prescription drug coverage.

(1) If you are not real familiar with a new area, you may find that there are not too many participating pharmacies nearby. We have spoken with people who live in such a remote area of the country that they have access to only one local pharmacy and mail-order is perhaps not an option because of your chosen plan (for instance, if you live on an island in Puget Sound). For another example, see the screen below for people living in ZIP Code 83429 that contains only a single (yes, 1) pharmacy within the surrounding 20 miles.

Reason (2) and Reason (3) deal with costs: Retail Drug Costs and Plan Coverage Costs

(2) As mentioned in the box above, each pharmacy can have a different negotiated retail drug cost for the same medication and same Medicare Part D prescription drug plan. In fact, a Medicare Part D plan can (at least in theory) have a different negotiated retail price with every pharmacy in their network, although this would be unlikely. Still, you will definitely notice that some medications have a much different retail price at the various pharmacies in your area for the same medication and you can change pharmacies in this Step 3 of 4 to see the differences. (Note: The retail price is important because it determines when you reach the Donut / Doughnut Hole or Coverage Gap. In other words, when the total retail value of your drug purchases exceeds your Initial Coverage Limit, you go into the Donut Hole.)

(3) January 1st begins a new Medicare Part D plan year and every year has a whole new set of Medicare Part D and Medicare Advantage plans in your area. In recent years, you may have noticed that more Medicare Part D plan now separate network pharmacies into several classes that have different coverage pricing (such as, network pharmacies and preferred network pharmacies). Key point: You may find that some Medicare Part D plans provide lower costing coverage prices or cost sharing at preferred network pharmacies and higher prescription drug prices at non-preferred network pharmacies. For example, if you see that "pharmacy ABC" now sponsors the "ABC Medicare prescription drug plan", you may find that you get better coverage prices at an "ABC pharmacy" whey you use your "ABC Medicare Part D plan". So, if you do not accurately select your local or usual pharmacy, your actual annual prescription costs may be significantly higher than you expected. In other words, the price at your pharmacy may not be the price you see on the Medicare.gov Plan Finder if you choose a pharmacy that you do not actually visit.
Also, in the unlikely event that your chosen pharmacy is not in a Medicare plan’s pharmacy network, the drug costs you will see in the Plan Finder are the full retail price of the drugs with no insurance coverage (again with emphasis — using a non-network pharmacy usually means you will pay full retail price for your medications).