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Is the retail drug price the same on every Medicare Part D plan?

Category: Monthly Formulary Changes
Published: Jul, 08 2014 03:07:55
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No. The negotiated retail drug price for each medication may differ:
  • between every Medicare Part D plan (or Medicare Advantage plan that includes prescription drug coverage),


  • pricing may also be different from the pharmacy’s every-day retail drug price.

For example, 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.

And, if you were to go to a different pharmacy using your same 2014 Medicare Part D plan, the negotiated retail drug price could also be different (see chart below illustrating an average negotiated retail drug price range from $18.18 to $230.97). 

The chart below shows a few examples of how the average price of Quetiapine Fumarate differs between a sample of stand-alone 2014 Medicare Part D plans in Florida – 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.

We also show in the chart how the average negotiated retail drug price has changed over the last few years.




QUETIAPINE FUMARATE 25MG TABLETS
on Florida Medicare Part D Plans

 

Plan's Average Negotiated
Retail Drug Price

Medicare Part D Plan Name

Dec. 2012

Dec. 2013

March 2014

June 2014

WellCare Plans (PDP)

$22.18

$19.25

$18.17

$18.18

AARP Plans (PDP)

$47.56

$16.39

$18.60

$18.29

Express Scripts Medicare - Value (PDP)

$73.16

$73.22

$59.41

$19.16

HealthMarkets Value Rx (PDP)

$25.83

$22.56

$22.44

$22.43

Cigna Medicare Rx Secure Plans (PDP)

$43.91

$19.30

$22.90

$23.06

Aetna Plans (PDP)

$73.34

$67.17

$54.40

$37.63

First Health Part D Value Plus (PDP)

$108.55

$73.46

$74.30

$44.58

Cigna-HealthSpring Rx -Reg 11 (PDP)

 

$92.34

$79.77

$65.10

United American Plans (PDP)

$109.17

$112.00

$106.43

$102.20

SilverScript Plans (PDP)

$186.93

 

$118.26

$135.78

Health First Basic Plan (PDP)

 

$121.16

$230.76

$230.97





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

The lowest average negotiated retail drug price was found on the WellCare and AARP plans (just over $18).  Whereas other plans have average negotiated retail drug prices well over $100.
 
Why is this 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).

  • What you will pay in the initial coverage phase, if your plan uses co-insurance (a percentage of the drug costs, for example: you pay a 25% co-insurance for a medication that has a negotiated retail drug price of $100, so you pay $25).

  • When you exceed your plan’s Initial Coverage Limit of $2,850 and move into the Coverage Gap (Donut Hole).  From the above example, the highest negotiated retail drug price of $230 will move you toward the Donut Hole much faster than the lowest negotiated retail price of $18.
  • Your cost-sharing while in the Donut Hole. In 2014, you receive a 28% discount on generic medications, so while in the Donut Hole, you would pay $5.09 on the WellCare plan as compared to $64.67 on the Health First Basic plan.

  • Your cost-sharing while in the Catastrophic Coverage phase.  You pay the greater of $2.55 or 5% of your plan’s negotiated retail drug price for generics.  So, you would pay $2.55 on the WellCare plan or $11.55 on the Health First Basic plan.

To give you an overview of pricing, we have added the average negotiated retail drug price in the far right column of our Drug Finder comparison chart.  Again, 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.  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.




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