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2013 Sees Increase in the Number of Medicare Part D Plans Using Preferred Network Pharmacy Pricing

Category: Pharmacies & Providers
Published: Jan, 21 2013 01:01:36
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In 2013, Medicare beneficiaries are finding more Medicare Part D plans that are using preferential pricing for "Preferred Network Pharmacies" vs. "Network Pharmacies."  During the 2012 plan year, only 11 stand-alone Medicare Prescription Drug plans (PDPs) used preferred network pharmacy pricing as compared to 24 plans in 2013.  All PDP plans that used this preferred network pricing strategy in 2012 continue to do so in 2013. 

Newcomers to this preferred network pricing structure for 2013 include plans from AARP, First United American, SilverScript, SmartD, and United American.  See the chart below for the full list of PDP plans using preferred network pharmacy pricing.  The list of Medicare Advantage plans (MAPDs) using preferred network pharmacy pricing follows in a second chart below. 

If your Medicare Part D plan is on one of the 2013 lists below, please be sure that your current pharmacy is a preferred network pharmacy.  Call your plan's member services telephone number on the back of your membership card to find preferred network pharmacies in your area.

Stand Alone Medicare Prescription Drug Plans Using Preferred Network Pharmacy Pricing
2012 Plans 2013 Plans
  AARP MedicareRx Enhanced (PDP)
AARP MedicareRx Preferred (PDP)
AARP MedicareRx Saver Plus (PDP)
Aetna CVS/pharmacy Prescription Drug Plan (PDP) Aetna CVS/pharmacy Prescription Drug Plan (PDP)
  BlueCross BlueShield Rx PDP (PDP)
BlueMedicare Rx-Option 1 (PDP) BlueMedicare Rx-Option 1 (PDP)
  BlueMedicare Rx-Option 2 (PDP)
Rite Aid EnvisionRxPlus (PDP) EnvisionRxPlus Gold (PDP)
  First Health Part D Essentials (PDP)
First Health Part D Value Plus (PDP) First Health Part D Value Plus (PDP)
  First United American - Enhanced (PDP)
First United American - Select (PDP)
Health Alliance Medicare Prescription Plan - Basic (PDP) Health Alliance Medicare Prescription Plan - Basic (PDP)
Humana Complete (PDP) Humana Complete (PDP)
Humana Enhanced (PDP) Humana Enhanced (PDP)
Humana Walmart-Preferred Rx Plan (PDP) Humana Walmart-Preferred Rx Plan (PDP)
PICA Alante (PDP) PICA Alante (PDP)
PICA Primero (PDP) PICA Primero (PDP)
  SilverScript Choice (PDP)
CVS Caremark Plus (PDP) SilverScript Plus (PDP)
  SmartD Rx Plus (PDP)
SmartD Rx Saver (PDP)
United American - Enhanced (PDP)
United American - Select (PDP)
Number of PDP Plans using Preferred Network Pharmacy Pricing:  11 Number of PDP Plans using Preferred Network Pharmacy Pricing:  24



The same trend appears in Medicare Advantage Plans with Prescription Drug Coverage.  In 2012, only 37 different MAPD plans used Preferred Network Pharmacy Pricing.  In 2013, 69 plans have Preferred Network Pharmacy Pricing. Newcomers to the new pricing structure include plans from Advantra, Blue Medicare Advantage, Coventry, Essence Advantage Health Alliance, Kaiser Permanente and Martin's Point Generations. See the chart below for details:

Medicare Advantage Plans with Prescription Drug Coverage Using Preferred Network Pharmacy Pricing
2012 Plans 2013 Plans
  Advantra (HMO)
Advantra (PPO)
Advantra Elite (HMO)
Advantra Freedom (PPO)
Advantra Freedom Plus (PPO)
Advantra Gold (PPO)
Advantra Option 1 (HMO)
Advantra Option 2 (HMO-POS)
Advantra Preferred (PPO)
Advantra Silver (HMO-POS)
Advantra Silver Plus (HMO-POS)
Altius Advantra (HMO-POS)
Blue Medicare Advantage Classic (HMO)
Blue Medicare Advantage Plus (HMO)
Blue Medicare Advantage Premier (HMO)
Care N' Care Health Plan I (PPO) Care N' Care Health Plan I (PPO)
Care N' Care Health Plan II (PPO) Care N' Care Health Plan II (PPO)
Care N' Care Health Plan III (PPO) Care N' Care Health Plan III (PPO)
  Coventry Advantage (HMO)
Coventry Advantra Platinum (PPO)
Coventry Advantra Silver (HMO)
Coventry Freedom (PPO)
Coventry Total Care (HMO)
Coventry Total Care (PPO)
Essence Advantage (HMO)
Essence Advantage Plus (HMO)
FHCP Medvantage Rx (HMO) FHCP Medvantage Rx (HMO)
FHCP Medvantage Rx Plus (HMO-POS) FHCP Medvantage Rx Plus (HMO-POS)
  Gold Advantage (HMO)
Health Alliance Medicare HMO Basic Rx (HMO-POS)
Health Alliance Medicare HMO20 Rx (HMO) Health Alliance Medicare HMO20 Rx (HMO)
Health Alliance Medicare PPO10 Rx (PPO) Health Alliance Medicare PPO10 Rx (PPO)
Health Alliance Medicare PPO30 Rx (PPO) Health Alliance Medicare PPO30 Rx (PPO)
  Humana Gold Choice H2944-204 (PFFS)
Humana Gold Choice H2944-204 (PFFS) Humana Gold Plus H2649-024 (HMO)
Humana Gold Plus H5291-002 (HMO) Humana Gold Plus H5291-002 (HMO)
Humana Gold Plus H5426-008 (HMO)  
Humana Reader's Digest Healthy Living Plan (HMO)  
HumanaChoice H0623-011 (PPO) HumanaChoice H0623-011 (PPO)
HumanaChoice H1716-020 (PPO) HumanaChoice H1716-020 (PPO)
HumanaChoice H6609-019 (PPO) HumanaChoice H6609-019 (PPO)
HumanaChoice H6609-022 (PPO) HumanaChoice H6609-022 (PPO)
HumanaChoice H6609-023 (PPO)  
HumanaChoice H7188-006 (PPO) HumanaChoice H7188-006 (PPO)
HumanaChoice H8644-005 (PPO) HumanaChoice H8644-005 (PPO)
  Kaiser Permanente Medicare Plus High w/Part D (AB) (Cost)
Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost)
Kaiser Permanente Medicare Plus Std w/Part D (B) (Cost)
Kaiser Permanente Senior Advantage Basic (HMO)
Kaiser Permanente Senior Advantage Enhanced (HMO)
KelseyCare Advantage Rx (HMO) KelseyCare Advantage Rx (HMO)
KelseyCare Advantage Rx + Choice (HMO-POS) KelseyCare Advantage Rx + Choice (HMO-POS)
  KelseyCare Advantage Rx Premier (HMO)
Leon Medical Centers Health Plans - Leon Cares (HMO) Leon Medical Centers Health Plans - Leon Cares (HMO)
  Martin's Point Generations Advantage Prime (HMO-POS)
  Martin's Point Generations Advantage Select (PPO)
  Martin's Point Generations Prime (HMO-POS)
MediSunONE Classic (HMO)  
MediSunONE Plus (HMO)  
MediSunONE Premier (HMO)  
  MedStar Medicare Choice (HMO)
MedStar Medicare Choice Plus (HMO)
Network PlatinumPlus Pharmacy (PPO) Network PlatinumPlus Pharmacy (PPO)
Network PlatinumPremier Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO)
Network PlatinumSelect (PPO) Network PlatinumSelect (PPO)
NetworkCares (PPO SNP) NetworkCares (PPO SNP)
Providence Medicare Choice + RX (HMO-POS) Providence Medicare Choice + RX (HMO-POS)
Providence Medicare Extra + RX (HMO) Providence Medicare Extra + RX (HMO)
Providence Medicare Extra Part B Only + RX (HMO) Providence Medicare Extra Part B Only + RX (HMO)
Providence Medicare Open + RX (PPO) Providence Medicare Open + RX (PPO)
Secure Blue (PPO) Secure Blue (PPO)
  Senior Advantage Medicare Medicaid Plan (HMO SNP)
True Blue Freedom (HMO) True Blue Freedom (HMO)
True Blue Rx Option I (HMO) True Blue Rx Op




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