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What is the difference between 2016 Preferred Network Pharmacies and Network Pharmacies?




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What is the difference between 2016 Preferred Network Pharmacies and Network Pharmacies?

Published on 2015-10-26 14:16:53Category: Pharmacies and Providers

First, both preferred and non-preferred network pharmacies are included in a Medicare prescription drug plan’s pharmacy network.  However, preferred network pharmacies usually have lower cost-sharing as compared to non-preferred network pharmacies.  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:

Comparing Preferred and non-Preferred Pharmacy Pricing
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
*Annual Cost Estimates from Medicare.gov Plan Finder 10/26/2016.
(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).


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