However, preferred network pharmacies usually have lower cost-sharing as compared to standard network pharmacies - meaning, you may pay less for your prescriptions at a preferred pharmacy as compared to a standard pharmacy - and you can see some 2018 examples below.
How do you know if your Medicare Part D plan uses preferred pharmacy pricing?
Both our PDP-Finder and MA-Finder show the note: "Higher cost-sharing at standard network pharmacies" if a drug plan uses preferred network pharmacy pricing – and again, this means the cost-sharing you pay is different depending on whether you purchase your medications from a preferred network pharmacy or a standard network pharmacy. You can see an "Rx$" icon after this note and then a link that will show you more details about the preferred vs. standard cost-sharing for the chosen Medicare Part D plan.
How many Medicare prescription drug plans use preferred pharmacy pricing?
About 98% of all 2018 stand-alone Medicare prescription drug plans (PDPs) will use different cost-sharing for preferred vs. standard (non-preferred) network pharmacies (as compared to 85% of all 2017). In fact, 779 stand-alone 2018 Medicare prescription drug plans will offer additional cost-sharing savings if you shop at one of their preferred network pharmacies.
Which 2017 Medicare Part D plans will start using preferred pharmacy pricing in 2018?
All 2017 stand-alone Medicare Part D plans renewing for 2018 continued with their same preferred vs. standard network pharmacy pricing strategies with the exception of the SilverScript Choice (PDP), WellCare Classic (PDP) and WellCare Extra (PDP) and the WPS MedicareRx Plan 1 and WPS MedicareRx Plan 2 in Wisconsin. These five plans will introduce preferred network pharmacy pricing strategies for 2018.
How do preferred and standard pharmacy co-payments compare?
As an example of different cost-sharing between network pharmacies, the chart below shows the variation between preferred and standard network pharmacies for the 2018 California SilverScript Choice (PDP) plan:
| California SilverScript Choice (S5601-064) | ||||||
| 30-Day Supply Cost-Sharing | 90-Day Supply Cost-Sharing | |||||
| Preferred Pharmacy | Standard Pharmacy |
Mail-Order | Preferred Pharmacy | Standard Pharmacy |
Mail-Order | |
| Initial Coverage Phase Cost-Sharing (before Donut Hole) |
||||||
| Tier 1 - Preferred Generic: | $3.00 | $7.00 | $3.00 | $7.50 | $21.00 | $0.00 |
| Tier 2 - Generic: | $13.00 | $20.00 | $13.00 | $32.50 | $60.00 | $32.50 |
| Tier 3 - Preferred Brand: | $42.00 | $47.00 | $42.00 | $105.00 | $141.00 | $105.00 |
| Tier 4 - Non-Preferred Brand: | 46% | 50% | 46% | 46% | 50% | 46% |
| Tier 5 - Specialty Tier: | 33% | 33% | 33% | n/a | n/a | n/a |
Note: The preferred and standard network pharmacy cost-sharing can vary by state. You can use our Rx$ 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 2018 WellCare Classic plan:
| Texas WellCare Classic (PDP) (S4802-013) | ||||||
| 30-Day Supply Cost-Sharing | 90-Day Supply Cost-Sharing | |||||
| Preferred Pharmacy | Standard Pharmacy |
Mail-Order | Preferred Pharmacy | Standard Pharmacy |
Mail-Order | |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1 - Preferred Generic: | $0.00 | $6.00 | $0.00 | $0.00 | $18.00 | $0.00 |
| Tier 2 - Generic: | $1.00 | $11.00 | $1.00 | $3.00 | $33.00 | $2.50 |
| Tier 3 - Preferred Brand: | $30.00 | $41.00 | $30.00 | $90.00 | $123.00 | $75.00 |
| Tier 4 - Non-Preferred Brand: | 42% | 50% | 42% | 42% | 50% | 42% |
| Tier 5 - Specialty Tier: | 25% | 25% | 25% | n/a | n/a | n/a |
Note: The preferred and standard network pharmacy cost-sharing can vary by state. You can use our Rx$ 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.
How about an actual example of how cost sharing can vary between preferred and standard pharmacies?
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.
Spoiler Alert: You may pay more for your medications at a standard or “non-preferred” network pharmacy - and you may pay a whole lot more for medications at a non-network pharmacy.
| 2017 Medicare Part D Plan Name | Annual Cost at CVS* | Annual Cost at Walmart* | Annual Cost at Walgreens* | Annual Cost Mail Order* |
| Blue Cross MedicareRx Value |
$1,023 (S) | $938 (P) | $940 (P) | $1,047 |
| WellCare Extra |
$714 (N) |
$714 (N) | $714 (N) |
$714 |
| Humana Enhanced |
$1,238 (S) | $,1118 (P) | $1,118 (P) | $1,102 |
| Magellan Rx Medicare Basic |
$1,912 (P) | $922 (P) | $1,225 (S) | $967 |
| AARP MedicareRx Walgreens |
$5,695 (non-network pharmacy) |
$5,695 (non-network pharmacy) |
$870 (P) | $984 |
| First Health Part D Value Plus |
$1,081(S) | $917 (P) | $921 (P) | $1,023 |
(P) Preferred network pharmacy pricing for the designated Medicare Part D plan
(S) Standard network pharmacy pricing for the designated Medicare Part D plan
(N) Cost-sharing is the same at all network pharmacies for the designated Medicare Part D plan
(non-network pharmacy) This pharmacy is not in the designated plan's pharmacy network.
Bottom Line: If you want to lower your prescription drug costs, make sure you are using one of your plan’s preferred network pharmacies (or mail order option).
How do we know which pharmacies have preferred or standard cost-sharing for our drug plan?
Your Medicare Part D plan documentation (Summary of Benefits and Evidence of Coverage ) should tell you whether your Medicare Part D plan has preferred cost-sharing. You might have also received a printed Pharmacy Directory that will tell you more about preferred / standard pharmacies in your area. (Look for text in your Evidence of Coverage document such as "The Pharmacy Directory will also tell you which of the pharmacies in our network have preferred cost-sharing, which may be lower than the standard cost-sharing offered by other network pharmacies.")
Medicare Part D plans also usually have an easily accessible online tool that allows you to search for network pharmacies in your area and then indicates which pharmacies are preferred or standard.
We also have a Blog section with tips to using some of the more popular Medicare plan pharmacy and provider searches
If you cannot find your plan's online pharmacy search, you can call the Medicare plan's Member Services toll-free number (found on enrollment information, printed plan information, and your Member ID card) and ask a Member Services representative to help you find a preferred pharmacy in your area or to send you a Pharmacy Directory.