Each Medicare Part D plan has a national pharmacy network that includes 50,000 to 60,000+ pharmacies and both "preferred" and "standard" pharmacies are included in a Medicare prescription drug plan’s pharmacy network.
However,
preferred network pharmacies usually have lower cost-sharing as compared to standard (formerly known as "non-preferred")
network pharmacies - meaning, you may pay less for your prescriptions at a preferred pharmacy as compared to a standard pharmacy - and you can see some 2017 examples below.
How do you know if your 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 see an "
Rx$" icon after this note and then a link that will show you more details about the preferred vs. standard cost-sharing for the chosen Medicare Part D plan.
How many Medicare prescription drug plans use preferred pharmacy pricing?
About
85% of all 2017 stand-alone Medicare prescription drug plans (PDPs) will
use different cost-sharing for preferred vs. standard (non-preferred) network
pharmacies.
In fact, 757 stand-alone 2017 Medicare prescription
drug plans will offer additional cost-sharing savings if you shop at one
of
their preferred network pharmacies.
What 2016 Medicare Part D plans are now using preferred pharmacy pricing in 2017?
All 2016 stand-alone Medicare Part D plans renewing for 2017 continued with their same preferred vs. standard network pharmacy pricing strategies with the exception of the
Blue Rx PDP Plus and
Complete plans in Pennsylvania and the
BlueCross Rx Plus plan in South Carolina. All three plans are now using preferred network pharmacy pricing strategies.
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
2017 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 |
Standard
Pharmacy
|
Mail-Order |
Preferred Pharmacy |
Standard
Pharmacy |
Mail-Order |
Initial Coverage Phase Cost-Sharing (before Donut Hole)
|
Tier 1 - Preferred Generic: |
$4.00 |
$8.00 |
N/A |
$12.00 |
$24.00 |
$0.00 |
Tier 2 - Generic: |
$10.00 |
$15.00 |
N/A |
$30.00 |
$45.00 |
$0.00 |
Tier 3 - Preferred Brand: |
$35.00 |
$38.00 |
N/A |
$105.00 |
$114.00 |
$90.00 |
Tier 4 - Non-Preferred Brand: |
37% |
43% |
N/A |
37% |
43% |
37% |
Tier 5 - Specialty Tier: |
33% |
33% |
N/A |
33% |
33% |
33% |
Note: The preferred and standard network pharmacy cost-sharing can vary by state. You can use our
Rx$ 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
2017 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 |
Standard
Pharmacy |
Mail-Order |
Preferred Pharmacy |
Standard
Pharmacy |
Mail-Order |
Initial Coverage Phase Cost-Sharing |
Tier 1 - Preferred Generic: |
$2.00 |
$10.00 |
$2.00 |
$6.00 |
$30.00 |
$6.00 |
Tier 2 - Generic: |
$5.00 |
$20.00 |
$5.00 |
$15.00 |
$60.00 |
$15.00 |
Tier 3 - Preferred Brand: |
$47.00 |
$47.00 |
$47.00 |
$141.00 |
$141.00 |
$141.00 |
Tier 4 - Non-Preferred Brand: |
50% |
50% |
50% |
50% |
50% |
50% |
Tier 5 - Specialty Tier: |
33% |
33% |
33% |
N/A |
N/A |
N/A |
Note: The preferred and standard network pharmacy cost-sharing can vary by state. You can use our
Rx$ 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.
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 or “non-preferred” network pharmacy - and you may pay a
whole lot more for medications at a non-network pharmacy.
2017 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
|
$1,023 (S) |
$938 (P) |
$940 (P) |
$1,047 |
WellCare Extra
|
$714 (N)
|
$714 (N) |
$714 (N)
|
$714 |
Humana Enhanced
|
$1,238 (S) |
$,1118 (P) |
$1,118 (P) |
$1,102 |
Magellan Rx Medicare Basic
|
$1,912 (P) |
$922 (P) |
$1,225 (S) |
$967 |
AARP MedicareRx Walgreens
|
$5,695
(non-network pharmacy) |
$5,695
(non-network pharmacy)
|
$870 (P) |
$984 |
First Health Part D Value Plus
|
$1,081(S) |
$917 (P) |
$921 (P) |
$1,023 |
*Annual Cost Estimates from Medicare.gov Plan Finder 02/07/2017.
(
P) Preferred network pharmacy pricing for the designated Medicare Part D plan
(S) Standard network pharmacy pricing for the designated Medicare Part D plan
(N) Cost-sharing is the same at all network pharmacies 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
2017 prescription drug costs, make sure you are using one of your plan’s preferred network
pharmacies (or mail order option).
How do we know which 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. You might have also received a printed Pharmacy Directory that will tell you more about preferred / standard pharmacies in your area. (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.")
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 Blog section with tips to using some of the more popular Medicare plan pharmacy and provider searches:
If you cannot find your plan's online pharmacy search, you can call your Medicare plan's Member Services toll-free number (found on 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.