(1) your pharmacy may no longer be included in your new Medicare plan's pharmacy network, and
(2) your pharmacy may no longer be a preferred network pharmacy and instead, your pharmacy is a non-preferred or standard network pharmacy with higher cost-sharing - meaning you will have drug coverage, but you will pay more for the coverage than you would at preferred network pharmacy.
Coverage at Network and non-Network Pharmacies
Each Medicare Part D plan has an individual network of pharmacies that is very large and probably includes over 50,000 retail pharmacies – plus your Medicare drug plan may include a mail order pharmacy.
However, even with such large pharmacy networks, you should always check with your local pharmacy to be sure that it is included in your newly chosen Medicare prescription drug plan’s pharmacy network.
Coverage at Standard (non-Preferred) Network Pharmacies and Preferred Network Pharmacies
Not only do you need to ensure that your pharmacy is a "network pharmacy", but you also want to check to see if you newly chosen Medicare prescription plan provides different drug pricing or cost-sharing for preferred network pharmacies, as compared to standard (non-preferred) network pharmacies.
As an example of different cost-sharing between network pharmacies, the chart below shows the variation between preferred and standard network pharmacies for the 2024 Ohio AARP Medicare Rx Walgreens from UHC (PDP) plan.
| Ohio AARP Medicare Rx Walgreens from UHC (PDP) (S5921-395) | ||||||
| 30-Day Supply Cost-Sharing | 90-Day Supply Cost-Sharing | |||||
| Preferred Pharmacy | Standard Pharmacy |
Preferred Mail-Order |
Preferred Pharmacy | Standard Pharmacy |
Preferred Mail-Order |
|
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1 - Preferred Generic: | $2.00 | $17.00 | n/a | $6.00 | $51.00 | $6.00 |
| Tier 2 - Generic: | $8.00 | $20.00 | n/a | $24.00 | $60.00 | $24.00 |
| Tier 3 - Preferred Brand: | $40.00 | $45.00 | n/a | $120.00 | $135.00 | $120.00 |
| Tier 4 - Non-Preferred Brand: | 50% | 50% | n/a | 50% | 50% | 50% |
| Tier 5 - Specialty Tier: | 27% | 27% | 27% | n/a | n/a | n/a |
Note: The preferred and standard network pharmacy cost-sharing can vary by state.
You can use our Rx$ icon on our PDP-Finder or MA-Finder to see the cost-sharing details for all tiers and pharmacies for any Medicare Part D or Medicare Advantage plan with prescription drug coverage.
As a second example, the chart below shows the variation between preferred and standard network pharmacies for the 2024 WellCare Classic plan.
| Texas WellCare Classic (PDP) (S4802-013) | ||||||
| 30-Day Supply Cost-Sharing | 90-Day Supply Cost-Sharing | |||||
| Preferred Pharmacy | Standard Pharmacy |
Preferred Mail-Order |
Preferred Pharmacy | Standard Pharmacy |
Preferred Mail-Order |
|
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1 - Preferred Generic: | $0.00 | $3.00 | $0.00 | $0.00 | $9.00 | $0.00 |
| Tier 2 - Generic: | $5.00 | $8.00 | $5.00 | $15.00 | $24.00 | $15.00 |
| Tier 3 - Preferred Brand: | 22% | 22% | 22% | 22% | 22% | 22% |
| Tier 4 - Non-Preferred Brand: | 42% | 42% | 42% | 42% | 42% | 42% |
| Tier 5 - Specialty Tier: | 25% | 25% | 25% | n/a | n/a | n/a |
| Tier 6 - Select Care Drugs: | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Note: The preferred and standard network pharmacy cost-sharing can vary by state.
You can use our Rx$ icon on our PDP-Finder or MA-Finder to see the cost-sharing details for all tiers and pharmacies for any Medicare Part D or Medicare Advantage plan with prescription drug coverage. Cost-Sharing Variations between Preferred Pharmacy
As an example of how the different cost-sharing could affect you, the chart below shows how the total prescription costs for three medications (Atorvastatin, Clopidogrel, and Esomeprazole Magnesium) can vary between network pharmacies (such as CVS, Walmart, or Walgreens), depending on your Medicare Part D plan.
Bottom Line #1: You may pay more for your medications at a “non-preferred” or standard network pharmacy
| 2024 Medicare Part D Drug Costs Only Without including plan premium |
||||
| 2024 Medicare Part D Plan Name | Annual Cost at CVS* | Annual Cost at Walmart* | Annual Cost at Walgreens* | Annual Cost Preferred Mail Order* |
| Cigna Saver Rx (PDP) | $513.00 (S) | $276.60 (P) | $249.12 (P) | $288.00 (P) |
| Humana Walmart Value Rx Plan (PDP) | $162.00 (S) | $82.80 (P) | $174.60 (S) | $92.40 (P) |
| AARP MedicareRx Walgreens (PDP) | $612.00 (S) | $612.00 (S) | $77.28 (P) | $77.24 (P) |
| SilverScript Plus | $0 (P) | $0 (P) | $55.56 (S) | $0 (P) |
| WellCare Value Script | $1,370.25 (P) | $1,625.00 (S) | $1.464.46 (P) | $1,510.90 (P) |
| Mutual of Omaha Rx Essential | $103.80 (P) | $175.80 (P) | $175.32 (S) | $129.60 (P) |
*Annual Drug Cost Estimates from Medicare.gov Plan Finder 10/22/2023 less the annual premium.
(P) This is a preferred network pharmacy for the designated Medicare Part D plan
(S) Standard network pharmacy pricing for the designated Medicare Part D plan
(non-network pharmacy) This pharmacy is not in the designated plan's pharmacy network.
Bottom Line #2: If your current retail pharmacy is considered one of your Medicare plan’s non-preferred or standard network pharmacies, your prescriptions will be covered, but you may pay more for your prescriptions than you would pay at one of your plan’s preferred network pharmacies (you can click here to read more). But, notice that you may even pay different prices at preferred network pharmacies.
Also, you can naturally check into your plan’s mail order options for additional drug cost savings.
Where to learn more?
See our article: Will preferred pharmacy pricing save you money in 2024?
You can review your Medicare Part D plan's written plan information to learn more about network / non-network pharmacies and preferred / standard network pharmacies.
If you need further assistance, you can telephone your Medicare Part D plan's Member Service number found on your Member ID card or your plan's printed information.
You can review your Medicare Part D plan's written plan information to learn more about network / non-network pharmacies and preferred / standard network pharmacies.
If you need further assistance, you can telephone your Medicare Part D plan's Member Service number found on your Member ID card or your plan's printed information.