A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu
  • Home
  • Contact
  • MAPD
  • PDP
  • 2024
  • 2025
  • FAQs
  • Articles
  • Search
  • Contact
  • 2024
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search

Can retail drug price vary between Medicare Part D drug plans?

Category: Retail Drug Pricing
Updated: Nov, 01 2023


Yes.  You will find that the negotiated retail drug price for each medication may differ between every Medicare Part D plan (PDP) or Medicare Advantage plan that includes prescription drug coverage (MAPD).

In addition, the retail price for a drug can vary:
  • from pharmacy-to-pharmacy, even for the same Medicare Part D plan,

  • between your Medicare plan's standard network pharmacies and preferred network pharmacies, and

  • from a specific network pharmacy’s every-day retail drug price.

Example:  How retail drug prices can vary between Medicare Part D drug plans and change over time.

If you purchase a formulary medication such as Quetiapine Fumarate, the generic for Seroquel®, you may see on your receipt a price slightly more or slightly less than someone who is enrolled in another Medicare prescription plan.  For example, back in 2021, the drug price ranged anywhere from $5.40 all the way up to $58.80 depending on the Medicare Part D plan.

The chart below shows the how average price of Quetiapine Fumarate differs between a sample of stand-alone Medicare Part D plans in Florida and across the years – the prices shown are the average negotiated retail drug price for each plan’s Florida service area and can vary from the pharmacy specific price shown on Medicare.gov and our negotiated retail price data.

(Please note, the National Drug Code (NDC) for this medication - QUETIAPINE FUMARATE 25 MG TABLET [Seroquel] (30 TABLETS ) - was 47335090288 in 2014, 16729014501 in 2019, 67877024201 in 2022 and 67877024210 in 2023.)

QUETIAPINE FUMARATE 25MG TABLETS
on
Florida Medicare Part D Plans
  Stand-alone Medicare Part D plan's
Average Negotiated Retail Drug Price
Medicare Part D Plan Name Dec. 2012 Dec. 2013 March 2014 June 2014 June 2019 August 2020

WellCare Plans (PDP)

$22.18 $19.25 $18.17 $18.18 $6.00 $11.40
AARP Plans (PDP) $47.56 $16.39 $18.60 $18.29 $8.10 $19.80
Express Scripts Medicare - Value (PDP) $73.16 $73.22 $59.41 $19.16 $20.12 $13.20
HealthMarkets Value Rx (PDP) $25.83 $22.56 $22.44 $22.43 n/a n/a
Cigna (HealthSpring) Medicare Rx Secure Plans (PDP) $43.91 $19.30 $22.90 $23.06 $7.10 $7.80
Aetna Plans (PDP) $73.34 $67.17 $54.40 $37.63 $44.93  $9.00
First Health Part D Value Plus (PDP) $108.55 $73.46 $74.30 $44.58 n/a n/a
Cigna-HealthSpring Rx (PDP) n/a $92.34 $79.77 $65.10 $15.44 $9.00
United American Plans (PDP) $109.17 $112.00 $106.43 $102.20 n/a n/a
SilverScript Plans (PDP) $186.93 n/a $118.26 $135.78 $7.58 $37.20
Health First Basic Plan (PDP) n/a $121.16 $230.76 $230.97 n/a n/a
EnvisionRxPlus (PDP) n/a $37.31 $45.67 $45.11 $65.35 $75.60

As you can see in the chart above, the average negotiated retail drug price can vary significantly from one Medicare plan to another.

You can see more current pricing for this generic drug [QUETIAPINE FUMARATE 25 MG TABLET] using our Q1Rx Drug Finder found at: Q1Rx.com/FL/67877024210.

And, if you visit a different pharmacy using your same Medicare Part D plan, the negotiated retail drug price could also be different (see chart below illustrating an average negotiated retail drug price ranges over time and between plan).



Example:  How retail drug prices can vary between pharmacies and 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 Finder


Question:  Why is your Medicare Part D plan's negotiated retail drug price important?

Your medication’s negotiated retail price is important because retail pricing is used to determine:
  • What you will pay in the deductible (if your plan has an initial deductible).  Remember, while in the deductible you pay 100% of the retail value until you meet your deductible.

  • What you will pay in the Initial Coverage Phase, if your plan uses co-insurance (a percentage of the drug costs, for example: you pay a 25% co-insurance for a medication that has a negotiated retail drug price of $20, so you pay $5).

  • When you exceed your plan’s Initial Coverage Limit and move into the Coverage Gap (or Donut Hole) - Your Initial Coverage Limit is calculated by the total retail value of your prescription purchases - so not what you pay, but the retail value.  If you purchase a drug with a $100 retail value and pay $25, the $100 retail value counts toward meeting the Initial Coverage Limit and entering the Donut Hole.  Therefore, from the chart above, you can imagine that the highest negotiated retail drug price of $75.60 will move you toward the Donut Hole much faster than the lowest negotiated retail price of $7.80.

  • Your cost-sharing while in the Donut Hole.  The Donut Hole discount is calculated based on the retail value of your medications.  You receive a 75% discount on all formulary medications while in the Donut Hole, so based on the chart above, you would pay $1.95 on the Cigna (HealthSpring) Medicare Rx Secure plan as compared to $18.90 on the EnvisionRxPlus plan.

  • Your cost-sharing while in the Catastrophic Coverage phase.  Cost sharing in the Catastrophic Coverage phase can change slightly year-to-year.  In 2021, you paid the greater of $3.70 or 5% of your plan’s negotiated retail drug price for generics.  So you would have paid $3.70 on both the WellCare and EnvisionRxPlus plans (5% of the retail price is less than $3.70 in both cases.)  In 2023, you will pay the greater of $4.15 or 5% of your plan’s negotiated retail drug price for generics.

    Keep in mind that 2023 is the last year that Medicare Part D beneficiaries will pay cost-sharing in the Catastrophic Coverage phase.  For plan year 2024, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing in the Catastrophic Coverage phase.

To give you an overview of pricing, we have the average negotiated retail drug price in the far right column of our Drug Finder comparison chart.  The average negotiated retail drug prices shown are the average of the negotiated retail drug prices for all pharmacies in the plan’s service area.

Please note that the average negotiated retail drug price can vary state-to-state.  In our Drug Finder, you can click on the average negotiated retail drug price to view the pricing history for a particular plan and drug.  The same average retail drug pricing information is also available when using our Formulary Browser and clicking on the 30-day supply or 90-day supply cost-sharing figures.







Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs


Browse FAQ Categories






Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.