Each Medicare Part D plan has a national pharmacy network that includes 50,000 to 65,000+ pharmacies and both "preferred" and "standard" pharmacies can be included in a Medicare prescription drug plan’s pharmacy network.

In 2021, about 98% of all stand-alone Medicare prescription drug plans (PDPs) will use different cost-sharing for preferred vs. standard (non-preferred) network pharmacies (as compared to 95% of all PDPs in 2020).  More specifically, 987 stand-alone 2021 Medicare prescription drug plans will offer additional cost-sharing savings if you shop at one of their preferred network pharmacies.

In general, preferred network pharmacies 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 (you can see some 2021 examples below).

Question:  How do I know if my 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 also see an "Rx$" icon after this note and a "Details" link showing you more information about preferred vs. standard cost-sharing for the chosen Medicare Part D plan.

Question:  Which 2020 Medicare Part D plans will start using preferred pharmacy pricing in 2021?

Only the Humana Basic Rx Plan (PDP) plan will introduce preferred vs. standard network pharmacy pricing strategies in 2021. However, four Blue plans will remove preferred pharmacy pricing. They include:

• Blue MedicareRx Value (PDP) in Arizona
• Blue MedicareRx Essential (PDP) in Arizona
• Blue MedicareRx Enhanced (PDP) in Arizona
• Prescription Blue Select (PDP) in Michigan

Question:  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 2021 California SilverScript Choice (PDP) plan.


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 2021 WellCare Classic plan.

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 network pharmacy (but not always!) — and you may pay a whole lot more for medications at a non-network pharmacy.


*Annual Drug Cost Estimates from Medicare.gov Plan Finder 10/4/2020 less the annual premium.

(P) Preferred network pharmacy pricing for the designated Medicare Part D plan
(S) Standard network pharmacy pricing for the designated Medicare Part D plan
(non-network pharmacy) This pharmacy is not in the designated plan's pharmacy network.

**Annual Drug Cost Estimates from Medicare.gov Plan Finder 10/4/2020.

(P) Preferred network pharmacy pricing for the designated Medicare Part D plan
(S) Standard network pharmacy pricing 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 preferred mail order option). HOWEVER, as noted in the charts above, it can happen that the retail prices at a standard network pharmacy may be lower and your plan's co-insurance is not significantly different between preferred and standard network pharmacies.

Question:  How do I know which specific 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.  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."  You might have also received a printed Pharmacy Directory that will tell you more about preferred / standard pharmacies in your area.  

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 News section with tips to using some of the more popular Medicare plan pharmacy and provider searches:  Q1News.com/C/24

If you cannot find your plan's online pharmacy search, you can call your 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.