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

Monthly Formulary changes · published Jul 8, 2014

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 - MAPD) and
  • a Medicare drug plan's retail drug 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 Medicare Part D plan, the negotiated retail drug price could also be different.

As shown in the older example below an average negotiated retail drug price for a common generic can range from $18.18 to $230.97.  

The chart illustrates how the average price of the generic 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 note in this example, 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).

  • If or when you enter the Catastrophic Coverage phase (if your plan charges coinsurance – that is, you pay a percentage of the retail cost).

To give you an overview of pricing, we have added the average negotiated retail drug price in the far right column of our the drug finder 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.