Both our PDP-Finder and MA-Finder show a note "Higher cost-sharing at non-preferred pharmacies" if a plan uses preferred network pharmacy pricing – meaning the cost-sharing is different if you purchase your medications from a preferred network pharmacy vs. a network pharmacy.
About 85% of all 2016 stand-alone Medicare prescription drug plans will use different cost-sharing for preferred vs. non-preferred network pharmacies. In fact, 897 stand-alone 2016 Medicare prescription drug plans will offer additional cost-sharing savings if you shop at one of their preferred network pharmacies. Counter to the "preferred pharmacy pricing" trend, all three stand-alone WellCare Medicare Part D plans will no longer use preferred pharmacy cost-sharing in 2016 and will instead use the same cost-sharing at all network pharmacies.
One notable 2016 change to preferred pharmacy pricing is the Aetna Medicare Rx Saver plan in AZ, CA, FL, NV, SC will join all other Aetna plans in using preferred pharmacy pricing in 2016. Other examples of plans moving to preferred pharmacy cost-sharing in 2016:
- Transamerica MedicareRx Classic plan will also now have different cost-sharing for preferred pharmacies
- Blue MedicareRx Premier (PDP) in CT MA RI VT
- BlueCross Rx Value (PDP) in SC
- SmartSaver Rx PDP Value (PDP) in NY
- Horizon Medicare Blue Rx Enhanced (PDP) in NJ
- MedicareBlue Rx Premier and Standard plans (PDP) in IA MN MT NE ND SD WY
As an example, the chart below shows the variation between preferred and “non-preferred” network pharmacies for the 2016 California AARP MedicareRx Preferred plan:
| California AARP MedicareRx Preferred (PDP) (S5820-031-0) | ||||||
| 30-Day Supply Cost-Sharing | 90-Day Supply Cost-Sharing | |||||
| Preferred Pharmacy | Non-Preferred | Mail-Order | Preferred Pharmacy | Non-Preferred | Mail-Order | |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1 - Preferred Generic: | $1.00 | $3.00 | N/A | $3.00 | $9.00 | $0.00 |
| Tier 2 - Generic: | $2.00 | $4.00 | N/A | $6.00 | $12.00 | $0.00 |
| Tier 3 - Preferred Brand: | $21.00 | $31.00 | N/A | $63.00 | $93.00 | $58.00 |
| Tier 4 - Non-Preferred Brand: | 30% | 40% | N/A | 30% | 40% | 30% |
| Tier 5 - Specialty Tier: | 25% | 25% | N/A | 25% | 25% | 25% |
Note: The preferred and network pharmacy cost-sharing on the AARP MedicareRx Preferred plan varies by state. You can use our Rx$ 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 “non-preferred” network pharmacies for the 2016 California First Health Value Plus plan:
| California First Health Part D Value Plus (PDP) (S5768-155-0) | ||||||
| 30-Day Supply Cost-Sharing | 90-Day Supply Cost-Sharing | |||||
| Preferred Pharmacy | Non-Preferred | Mail-Order | Preferred Pharmacy | Non-Preferred | Mail-Order | |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1 - Preferred Generic: | $1.00 | $10.00 | $10.00 | $3.00 | $30.00 | $30.00 |
| Tier 2 - Generic: | $7.00 | $20.00 | $20.00 | $21.00 | $60.00 | $60.00 |
| Tier 3 - Preferred Brand: | $47.00 | $47.00 | $47.00 | $141.00 | $141.00 | $141.00 |
| Tier 4 - Non-Preferred Brand: | 50% | 50% | 50% | 50% | 50% | 50% |
| Tier 5 - Specialty Tier: | 33% | 33% | 33% | N/A | N/A | N/A |
Note: The preferred and network pharmacy cost-sharing on the First Health Part D Value Plus plan varies by state. You can use our Rx$ 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.
Preferred Pharmacy Cost-Sharing Example
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. Bottom Line: you may pay more for your medications at a “non-preferred” network pharmacy.
| 2016 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 plan | $928 (P) | $930 (P) | $931 (P) | $1,023 |
| Symphonix Value Rx plan | $1,080 (P) | $1,081 (P) | $1,104 | $1,106 |
| Symphonix PrimeSaver Rx plan | $1,177 (P) | $1,177 (P) | $1,356 | $1,203 |
| Magellan Rx Medicare Basic plan | $1,256 (P) | $1,256 (P) | $1,356 | $1,301 |
| AARP MedicareRx Saver Plus plan | $1,310 | $1,310 (P) | $1,137 (P) | $1,115 |
| Cigna-HealthSpring Rx Secure-Extra plan | $1,684 | $1,120 (P) | $1,127 (P) | $1,100 |
(P) This is a preferred network pharmacy for the designated Medicare Part D plan
Bottom Line: If you want to lower your 2016 prescription drug costs, make sure you are using your plan’s preferred network pharmacies (or, if available, the mail order option).