It depends. In general, as you travel across the country, you should pay the same amount for your formulary medications when you visit any of your Medicare plan's network pharmacies.
Your plan’s drug copayments may vary between
standard and preferred network pharmacies, but copays at the same national pharmacy should remain consistent as you travel. For example, if you visit a CVS pharmacy in Ohio and have a fixed $30 copay for a specific medication, then you will have a $30 copay for the same medication at a CVS in California.
Example: Copayment prices can vary between standard network pharmacies and preferred network pharmacies.
Here is an example showing how copayments can vary between preferred and standard network
pharmacies using the
2024 California SilverScript Choice (PDP) plan:
California SilverScript Choice (S5601-064) |
|
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: |
$2.00 |
$8.00 |
$2.00 |
$6.00 |
$24.00 |
$6.00 |
Tier 2 - Generic: |
$7.00 |
$15.00 |
$7.00 |
$21.00 |
$45.00 |
$21.00 |
Tier 3 - Preferred Brand: |
16% |
16% |
16% |
16% |
16% |
16% |
Tier 4 - Non-Preferred Brand: |
36% |
36% |
36% |
36% |
36% |
36% |
Tier 5 - Specialty Tier: |
25% |
33% |
33% |
n/a |
n/a |
n/a |
Note: The preferred and standard network pharmacy cost-sharing can vary by state. You can use our
Rx$ 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.
Bottom Line #1: You should pay the same fixed copays
as you travel across country, but copays can vary between standard and
preferred network pharmacies.
The good news is that you probably will have no problem finding one of your Medicare plan's preferred network pharmacies as you travel. Most Medicare prescription drug plans include more than 50,000
to 60,000 pharmacies in their network - and, as you travel, you can always call your
Medicare
Part D plan to find a nearby preferred network pharmacy - the toll-free number for your Medicare Part D plan's Member Services department is found on your Member ID card.
If your Medicare Part D plan is using coinsurance (you pay a percentage of retail, such as 25% of the retail drug cost), you may find that, since retail drug pricing can vary between different pharmacies across the country – and retail drug prices can change over time – your formulary drug cost can also change.
For example, if you pay a fixed 25% of the $80 retail price for your Tier 3 medication in Ohio, then 2-months later, you may find that you are now paying 25% of the $100 retail price in California for the same medication. In other words, the retail price of your medication increased during the two months and you are now paying $25 for your Tier 3 medication instead of the earlier $20.
Example: Retail drug prices vary slightly pharmacy-to-pharmacy and can change over time.
Here is a short example
from 2016
using three popular brand-name medications and two different network
pharmacies in three different states (for this example Medicare Part D
plan, CVS pharmacy has "Standard Cost Sharing" and Walmart pharmacy has
"Preferred Cost Sharing").
As you can see we are actually comparing
three different 2016
"AARP MedicareRx Preferred (PDP)" Medicare Part D plans in three
different regions to show that retail drug prices can stay
consistent across the country - although retail prices can vary slightly between
different network pharmacies.
|
2016 AARP MedicareRx Preferred (PDP)
Retail Drug Prices Across the Country
|
Example
Drugs
|
(S5820-013-0)
44319 (Summit,
Ohio)
|
|
(S5820-031-0)
90001
(Los Angeles, California) |
|
(S5820-010-0)
33034 (Miami-Dade, Florida)
|
|
|
CVS
(standard)
|
Walmart
(preferred)
|
CVS
(standard)
|
Walmart
(preferred) |
CVS
(standard)
|
Walmart
(preferred)
|
Advair Diskus 250/50
|
$336.50
|
$334.97
|
$336.50 |
$334.97 |
$336.50
|
$334.97
|
Crestor 10MG
|
$249.96
|
$248.85
|
$249.96 |
$248.85 |
$249.96
|
$248.85
|
Januvia 100MG
|
$365.40
|
$363.73
|
$365.40 |
$363.73 |
$365.40
|
$363.73
|
(Source: Medicare.gov Plan Finder 07/12/2016) Also see our
2016 Medicare Part D plan Archive
Here is the same example
with 2018 retail price data (and the
addition of a generic equivalent). Please note the change in the drugs'
negotiated retail drug prices over these two years. On a positive
note, again we see that retail drug prices can remain consistent as you
visit the same pharmacy (preferred network pharmacy (example: Walmart pharmacy)
or standard network pharmacy (example: CVS pharmacy)) located in different parts
of the country.
|
2018 AARP MedicareRx Preferred (PDP)
Retail Drug Prices Across the Country
|
|
(S5820-013-0)
44319 (Summit,
Ohio)
|
|
(S5820-031-0)
90001
(Los Angeles, California) |
|
(S5820-010-0)
33034 (Miami-Dade, Florida)
|
|
Example
Drugs |
CVS
(standard) |
Walmart
(preferred)
|
CVS
(standard) |
Walmart
(preferred) |
CVS
(standard) |
Walmart
(preferred)
|
Advair Diskus 250/50
|
$425.03
|
$414.81
|
$425.03 |
$414.81 |
$425.03
|
$414.81
|
Crestor 10MG
|
$314.07
|
$313.07
|
$314.07 |
$313.07 |
$314.07
|
$313.07
|
Januvia 100MG
|
$463.42
|
$452.37
|
$463.42 |
$452.37 |
$463.42
|
$452.37
|
Rosuvastatin Calcium TAB 100MG
(generic Crestor)
|
$16.54
|
$12.11
|
$16.54 |
$12.11 |
$16.54
|
$12.11
|
(Source: Medicare.gov Plan Finder 06/08/2018) and see our
Q1Rx.com Medicare Part D Drug FinderQuestion: What if I am traveling while in the Coverage Gap or Donut Hole?
If you have spent your way through your
Initial Coverage Period and entered your Medicare drug plan's Coverage Gap or Donut Hole, you will pay
25% of the retail price
for your formulary brand-name and generic medications. So, if you were paying a fixed $30 copay for a formulary drug, you will now be 25% of the drug's retail price.
This means: Even though we say the Donut Hole is "closed", you may find that when you enter the Coverage Gap
(Donut Hole) the cost of your formulary medications can
increase, decrease, or stay the same - depending on your Medicare drug plan, your
cost-sharing, and the drug's retail price.
Again, the Donut Hole discount will be applied to your plan's
negotiated
retail price that can vary between network and preferred network
pharmacies and even between preferred pharmacies. So like our example
above, if you are traveling while in the Donut Hole, you may pay
different prices for your formulary medications, depending on the retail
drug prices at your
chosen pharmacy.
You can learn more in on our FAQ "
Did the Coverage Gap or Donut Hole just close up and go away?"
Bottom Line #2: Formulary prescription costs based on retail drug prices can vary pharmacy-to-pharmacy and over time.
If you travel across the country and
use different network pharmacies, and either pay coinsurance (such as
25% of retail) or are in the Coverage Gap (Donut Hole), your coverage costs can vary
between the different pharmacies or over time as retail drug prices change.
You can contact your Medicare plan's Member Services (the telephone
number is on your Member ID card) to learn more about what you will pay
as you travel.
Related Question: What happens if we permanently move to another part of the country?
If you move to
another state or
Medicare Part D region and leave your plan's Service Area, you are granted a
Special Enrollment Period (SEP) and this
SEP allows you to join a new Medicare plan (Medicare Part D or Medicare Advantage plan) in your new location.
When looking at plans available in your new area, you may find that
the same Medicare Part D plans are not offered in all areas of the country - or you may find that if the same Medicare Part D
plan is available, but the plan has a different formulary and
cost-sharing structure that is tailored to your location.
In this case, it is possible that when you join another Medicare Part D plan in a new area, your cost-sharing for
your medications can be different.
Important: Learn
about your Medicare Part D plan or Medicare Advantage plan options before moving (for assistance, call a
Medicare representative at 1-800-633-4227).
Related Question: How does all this apply to Medicare Advantage plans that include prescription drug coverage (MAPD)?
All of this information is applicable to stand-alone Medicare Part D
prescription drug plans (PDPs) or Medicare Advantage plans that include
prescription drug
coverage (
MAPDs).
MAPDs have a Service Area often defined only by a ZIP code
(or county or partial-ZIP) and if you move to another county or city
that is only a few miles from your
original residence, you can find that your Medicare Advantage plan is
not
available or you may find that your coverage
is different in the
location - even when your Medicare Advantage plan has the same name or -
even when you
are still within the same state. In other words, you may find that you
can join an MAPD with the same name, but the coverage and cost can vary
in your new location.