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Archive: If I join the Humana Walmart Medicare drug plan, am I required to get all of my prescriptions from Walmart?

Archive · updated Nov 16, 2023

No, you are not required to use Walmart as your only pharmacy.  Humana Medicare Part D plans include over 50,000+ pharmacies in their pharmacy network.

However, if you are enrolled in the Humana Walmart Value Rx Plan (or Humana  Premier Rx Plan), Walmart, Neighborhood Market Pharmacies, Sam’s Club and Humana Mail-Order are “Preferred Pharmacies” may have the lowest cost-sharing - and according to Humana, there are over 5,200 preferred network pharmacies across the country.

You can use other pharmacies in the Humana Pharmacy Network, but the cost-sharing amount may be higher for drugs purchased outside of a preferred network pharmacy.

To find a Humana network pharmacy, please see:
www.humana.com/finder/pharmacy/

As noted by Humana:

"Humana has contracted with Walmart, Walmart Neighborhood Markets and Sam's Club pharmacies to offer preferred cost sharing for this Part D plan. While you can use other pharmacies in our network, preferred cost-sharing pharmacies offer additional prescription savings to Humana members."
Here is an example showing the different cost-sharing levels for the Humana Walmart Value Rx plan in New York for preferred network pharmacies (like Walmart) and standard network pharmacies:

2024
Copay/Coinsurance Amounts
PHARMACY TYPE TIER NAME Preferred Pharmacy Standard Pharmacy
RETAIL
(30-day Supply)
Tier 1: Preferred Generic $0 $10
Tier 2: Generic $1 $20
Tier 3: Preferred Brand 13% 18%
Tier 4: Non-Preferred Brand 44% 44%
Tier 5: Specialty Tier 25% 25%
MAIL-ORDER
(90-day Supply)
Tier 1: Preferred Generic $0 $30
Tier 2: Generic $3 $60
Tier 3: Preferred Brand 13% 18%
Tier 4: Non-Preferred Brand 44% 44%
Tier 5: Specialty Tier n/a n/a
Low-costing Tier 1 and Tier 2 drugs are also excluded from the Initial Deductible. 

The 2024 Humana Walmart Value Rx Plan (PDP) plan has a $545 Initial Deductible; however Tier 1 and 2 generics are excluded from the deductible (or a $0 deductible for Tier 1 and Tier 2 drugs).

This means that any Tier 1 or Tier 2 drug purchases you make will fall receive immediate coverage and will not be subject to the $545 initial deductible. However, your Tier 3, Tier 4, and Tier 5 prescription purchases are 100% your responsibility until you have met $545 deductible--then your Part D plan coverage begins.

If you would like to see how your medications are covered by this prescription drug plan, you can review the Humana Walmart formulary by going to our Medicare Part D Plan Finder (PDP-Finder.com), then choosing your state from the list and then scroll down to the Humana plans.

You will see a link in the right column of the chart that states: "Browse Formulary".  This link will take you to the plan's formulary.

You can also see all Medicare Part D plan formularies using our Formulary Browser found at: (Formulary-Browser.com).

As reference, here is a link to the 2024 New York Humana Walmart Value Rx Plan formulary and 2024 New York Humana Walmart Value Rx plan cost-sharing details.

You can see all Medicare Part D plans in your area by using our Medicare Part D Plan Finder PDP-Finder.com  (just choose a state to begin) or see all Medicare Advantage plans in your area using our Medicare Advantage Plan Finder MA-Finder.com (just choose state and county or enter your ZIP).

Reference:
(www.humana.com/medicare/part-d-2020/walmart-value-rx)