The answer depends on your chosen Medicare plan and whether your Medicare prescription drug plan uses preferred network pharmacy pricing.
- If you have preferred/standard pharmacies in your Medicare drug plan's pharmacy network - you will pay the stated copay or cost-sharing at preferred pharmacies and possible more at a standard network pharmacy.
- If the plan does not have preferred pharmacies so the cost-sharing shown in a Medicare Part D plan’s formulary is for all network pharmacies (for example, the $1 co-pay or 20% co-insurance at any network pharmacy).
As a note, most Medicare prescription drug plans have preferred pharmacy pricing, meaning you will pay less for you formulary medications at a preferred network pharmacy as compared to a non-preferred network pharmacy.
In our Medicare Part D Plan Finder (PDP-Finder.com), we indicate the drug plans that use both preferred pharmacy and the non-preferred network pharmacy pricing with the text, "Non-preferred network pharmacies have higher cost-sharing" shown below the plan details.
Example: For instance, if you were looking for a Florida stand-alone Medicare Part D plan (you can change the state to whatever you wish), you could view the plans at the following link: PDP-Finder.com/FL.
You will notice in the following graphic that the Medicare Part D plans are sorted with the lowest monthly premium first and below the plan information, you can see text reading: "Higher cost-sharing at standard network pharmacies" (this text will be added as cost-sharing data becomes available).
The PDP-Finder Plan Finder shows a link "Benefit & Contact Info" that will show you the different pricing (preferred and non-preferred) for this Medicare Part D plan’s formulary drug tiers.
On this page, please notice that Tier 1 Preferred Generics will cost a $0.00 co-payment when purchased at a preferred network pharmacy or a $5.00 co-pay when this same generic is purchased at a standard network pharmacy. Tier 2 Generics will have a co-pay of $2.00 at a preferred network pharmacy and a $10.00 co-pay at a standard network pharmacy.
Note: You will also notice that all formulary tiers have preferred pharmacy pricing when purchased through the plan's mail-order option.
On to the second point: cost-sharing during the deductible period is also a relatively new feature in some Medicare Part D plans.
Usually when a plan has a $445 initial deductible, you will pay the first $445 toward your medications before your plan’s coverage begins. However, many Medicare Part D drug plans now have certain drug tiers (usually low cost Tier 1 and Tier 2 generics) that are exempt from the deductible so you get coverage from the very start as if you had no deductible. Other than our Medicare Part D Plan Finder (PDP-Finder.com) and Medicare Advantage Plan Finder (MA-Finder.com), our Formulary Browser also shows that a particular drug Tier is exempt from the plan’s initial deductible.
The following graphic shows an example of Atorvastatin 10mg as a Tier 1 Preferred Generic with an average negotiated retail cost of around $6 and a co-payment of $5.00 when purchased at a preferred network pharmacy during the Initial Coverage Phase (there is no deductible). The standard pharmacy co-payment is $15, but you would actually never pay more than retail cost for your drugs, even when the co-payment is higher. So at a standard network pharmacy you would pay around $6 (or the plan's full negotiated retail cost that is under the $15 co-pay).
