Can retail drug price vary between Medicare Part D drug plans?

Yes. You will find that the negotiated retail drug price for each medication may differ between every Medicare Part D plan (PDP) or Medicare Advantage plan that includes prescription drug coverage (MAPD).

In addition, the retail price for a drug can vary:

from pharmacy-to-pharmacy, even for the same Medicare Part D plan,
between your Medicare plan's standard network pharmacies and preferred network pharmacies, and
from a specific network pharmacy’s every-day retail drug price.

Example: How retail drug prices can vary between Medicare Part D drug plans and change over time.

If you purchase a formulary medication such as Quetiapine Fumarate, the generic for Seroquel®, you may see on your receipt a price slightly more or slightly less than someone who is enrolled in another Medicare prescription plan. For example, back in 2021, the drug price ranged anywhere from $5.40 all the way up to $58.80 depending on the Medicare Part D plan.

The chart below shows the how average price of Quetiapine Fumarate differs between a sample of stand-alone Medicare Part D plans in Florida and across the years – the prices shown are the average negotiated retail drug price for each plan’s Florida service area and can vary from the pharmacy specific price shown on Medicare.gov and our negotiated retail price data.

(Please note, the National Drug Code (NDC) for this medication - QUETIAPINE FUMARATE 25 MG TABLET [Seroquel] (30 TABLETS ) - was 47335090288 in 2014, 16729014501 in 2019, 67877024201 in 2022 and 67877024210 in 2023.)

QUETIAPINE FUMARATE 25MG TABLETS on Florida Medicare Part D Plans
Stand-alone Medicare Part D plan's Average Negotiated Retail Drug Price
Medicare Part D Plan Name	Dec. 2012	Dec. 2013	March 2014	June 2014	June 2019	June 2025
WellCare Plans (PDP)	$22.18	$19.25	$18.17	$18.18	$6.00	$5.68 to $20.77
AARP Plans (PDP)	$47.56	$16.39	$18.60	$18.29	$8.10	$0.55 to $6.55
Express Scripts Medicare - Value (PDP)	$73.16	$73.22	$59.41	$19.16	$20.12	$13.20
HealthMarkets Value Rx (PDP)	$25.83	$22.56	$22.44	$22.43	n/a	n/a
Cigna (HealthSpring) Medicare Rx Secure Plans (PDP)	$43.91	$19.30	$22.90	$23.06	$7.10	$5.09 to $8.64
Aetna Plans (PDP)	$73.34	$67.17	$54.40	$37.63	$44.93	n/a
First Health Part D Value Plus (PDP)	$108.55	$73.46	$74.30	$44.58	n/a	n/a
Cigna-HealthSpring Rx (PDP)	n/a	$92.34	$79.77	$65.10	$15.44	n/a
United American Plans (PDP)	$109.17	$112.00	$106.43	$102.20	n/a	n/a
SilverScript Plans (PDP)	$186.93	n/a	$118.26	$135.78	$7.58	$5.29
Health First Basic Plan (PDP)	n/a	$121.16	$230.76	$230.97	n/a	n/a
EnvisionRxPlus (PDP)	n/a	$37.31	$45.67	$45.11	$65.35	n/a

As you can see in the chart above, the average negotiated retail drug price can vary significantly from one Medicare plan to another.

You can see more current pricing for this generic drug [QUETIAPINE FUMARATE 25 MG TABLET] using our the drug finder Drug Finder found at on this site67877024210.

And, if you visit a different pharmacy using your same Medicare Part D plan, the negotiated retail drug price could also be different (see chart below illustrating an average negotiated retail drug price ranges over time and between plan).

Example: How retail drug prices can vary between pharmacies and change over time.

Here is a short example from 2016 using three popular brand-name medications and two different network pharmacies in three different states (for this example Medicare Part D plan, CVS pharmacy has "Standard Cost Sharing" and Walmart pharmacy has "Preferred Cost Sharing").

As you can see we are actually comparing three different 2016 "AARP MedicareRx Preferred (PDP)" Medicare Part D plans in three different regions to show that retail drug prices can stay consistent across the country - although retail prices can vary slightly between different network pharmacies.

2016 AARP MedicareRx Preferred (PDP) Retail Drug Prices Across the Country
Example Drugs	(S5820-013-0) 44319 (Summit, Ohio)		(S5820-031-0) 90001 (Los Angeles, California)	(S5820-010-0) 33034 (Miami-Dade, Florida)
CVS (standard)	Walmart (preferred)	CVS (standard)	Walmart (preferred)	CVS (standard)	Walmart (preferred)
Advair Diskus 250/50	$336.50	$334.97	$336.50	$334.97	$336.50	$334.97
Crestor 10MG	$249.96	$248.85	$249.96	$248.85	$249.96	$248.85
Januvia 100MG	$365.40	$363.73	$365.40	$363.73	$365.40	$363.73

(Source: Medicare.gov Plan Finder 07/12/2016) Also see our 2016 Medicare Part D plan Archive

Here is the same example with 2018 retail price data (and the addition of a generic equivalent). Please note the change in the drugs' negotiated retail drug prices over these two years. On a positive note, again we see that retail drug prices can remain consistent as you visit the same pharmacy (preferred network pharmacy (example: Walmart pharmacy) or standard network pharmacy (example: CVS pharmacy)) located in different parts of the country.

2018 AARP MedicareRx Preferred (PDP) Retail Drug Prices Across the Country
(S5820-013-0) 44319 (Summit, Ohio)		(S5820-031-0) 90001 (Los Angeles, California)	(S5820-010-0) 33034 (Miami-Dade, Florida)
Example Drugs	CVS (standard)	Walmart (preferred)	CVS (standard)	Walmart (preferred)	CVS (standard)	Walmart (preferred)
Advair Diskus 250/50	$425.03	$414.81	$425.03	$414.81	$425.03	$414.81
Crestor 10MG	$314.07	$313.07	$314.07	$313.07	$314.07	$313.07
Januvia 100MG	$463.42	$452.37	$463.42	$452.37	$463.42	$452.37
Rosuvastatin Calcium TAB 100MG (generic Crestor)	$16.54	$12.11	$16.54	$12.11	$16.54	$12.11

(Source: Medicare.gov Plan Finder 06/08/2018) and see our on this site Medicare Part D Drug Finder Question: Why is your Medicare Part D plan's negotiated retail drug price important?

Your medication’s negotiated retail price is important because retail pricing is used to determine:

What you will pay in the deductible (if your plan has an initial deductible). Remember, while in the deductible you pay 100% of the retail value until you meet your deductible.
What you will pay in the Initial Coverage phase, if your plan uses coinsurance (a percentage of the drug costs, for example: you pay a 25% coinsurance for a medication that has a negotiated retail drug price of $20, so you pay $5).
Important Fact: 2024 was the last year that the Donut Hole existed.

In 2025 the Inflation Reduction Act (IRA) eliminated of the Coverage Gap (Donut Hole). Medicare Part D beneficiaries stay in the Initial Coverage phase until they reach the maximum cap on out-of-pocket spending for Part D formulary drugs - RxMOOP - which is set at $2,000 in 2025 ($2,100 in 2026 ). After reaching the RxMOOP Medicare Part D beneficiaries will have a $0 copay for all formulary drugs.

Prior to 2025, when you exceeded your plan’s Initial Coverage Limit (ICL) and moved into the Coverage Gap (or Donut Hole) - Your out-of-pocket spending for reaching the ICL was calculated by the total retail value of your prescription purchases - so not what you pay, but the retail value. If you purchased a drug with a $100 retail value and paid $25, the $100 retail value counted toward meeting the ICL and entering the Donut Hole. Therefore, from the chart above, you can imagine that the higher the negotiated retail drug price, the faster you moved toward the Donut Hole. Your cost-sharing while in the Donut Hole. The Donut Hole discount was calculated based on the retail value of your medications. You received a 75% discount on all formulary medications while in the Donut Hole.
2023 was the last year that Medicare Part D beneficiaries paid cost-sharing in the Catastrophic Coverage phase. For plan year 2024 and beyond, the Inflation Reduction Act (IRA) eliminated beneficiary cost-sharing in the Catastrophic Coverage phase.

Prior to plan year 2024, your cost-sharing while in the Catastrophic Coverage phase was based on your medication's retail drug price. Cost sharing in the Catastrophic Coverage phase changed slightly year-to-year. In 2021, you paid the greater of $3.70 or 5% of your plan’s negotiated retail drug price for generics. So you would have paid $3.70 on both the WellCare and EnvisionRxPlus plans (5% of the retail price is less than $3.70 in both cases.) In 2023, you paid the greater of $4.15 or 5% of your plan’s negotiated retail drug price for generics.

To give you an overview of pricing, we have the average negotiated retail drug price in the far right column of our Drug Finder comparison chart. The average negotiated retail drug prices shown are the average of the negotiated retail drug prices for all pharmacies in the plan’s service area.

Please note that the average negotiated retail drug price can vary state-to-state. In our Drug Finder, you can click on the average negotiated retail drug price to view the pricing history for a particular plan and drug. The same average retail drug pricing information is also available when using our Formulary Browser and clicking on the 30-day supply or 90-day supply cost-sharing figures.