Yes.  If your Medicare Part D prescription drug plan cost-sharing is based on a percentage of retail price (such as 25% coinsurance), you will find your coverage cost can increase (or decrease) due to the changes in your drug’s retail price – even if you always use the same pharmacy (although in recent years, retail drug pricing has become a bit more stable for many drugs).

For example, if you are in your plan's Initial Coverage phase - and your cost-sharing is 25% coinsurance - and your formulary medication has a retail price of $400 in January, then you will pay $100 for cost-sharing when purchasing your medication (25% of $400).

If the retail drug price increases to $450 in March, you would pay $113 for the same prescription (25% of $450).

Please remember that your plan's negotiated retail drug prices can vary over time, between network pharmacies (preferred and standard pharmacies) -- and even between preferred network pharmacies.


Question:  Where can I learn more about my Medicare Part D plan's cost sharing and retail drug information?

(1)  You can telephone your Medicare Part D plan's Member Services department using the toll-free telephone number found on your Member ID card.

(2)  You can telephone a Medicare representative at 1-800-Medicare (1-800-633-4227) and ask for an estimated retail drug price at your chosen pharmacy.

(3)  You can use our Q1Rx Drug Finder (Q1Rx.com) to see how all Medicare Part D prescription drug plans (or Medicare Advantage plans that include drug coverage (MAPDs)) in your area cover a specific drug.  We include the cost-sharing (copays or coinsurance percentage) along with average retail drug cost (when available).

In the following example, we show the coverage for ADVAIR DISKUS MIS 250/50 across all 2023 Florida Medicare Part D plans cover this medication.  You can see in the screenshot below that the first Florida Part D plan has coinsurance of 25% of retail and the next plan has a copay of $44, and so on.

The estimated average retail cost at this specific time is $424.20* (averaged across all network pharmacies in Florida).  So, the coverage for this drug is 25% of $424.20 or around $106 (with the actual cost possibly varying at different pharmacies).  You can repeat the search using Q1Rx.com/2023/FL/00173069600 to see any changes in the average retail drug cost that would affect the cost-sharing or coverage cost.