First, both preferred and non-preferred network pharmacies are included in a Medicare prescription drug plan’s pharmacy network. However,
preferred network pharmacies usually have lower cost-sharing as compared to non-preferred
network pharmacies.
Both our
PDP-Finder
and
MA-Finder
show a note "Higher cost-sharing at non-preferred pharmacies" if a plan uses preferred
network pharmacy pricing – meaning the cost-sharing is different if you
purchase your medications from a preferred network pharmacy vs. a network
pharmacy.
About 85% of all 2016 stand-alone Medicare prescription drug plans will
use different cost-sharing for preferred vs. non-preferred network
pharmacies.
In fact, 897 stand-alone 2016 Medicare prescription
drug plans will offer additional cost-sharing savings if you shop at one
of
their preferred network pharmacies. Counter to the "preferred pharmacy pricing" trend, all three
stand-alone WellCare Medicare Part D plans will no longer use preferred
pharmacy cost-sharing in 2016 and will instead use the same cost-sharing
at all network pharmacies.
One notable 2016 change to preferred pharmacy pricing is the
Aetna Medicare Rx Saver plan in AZ,
CA,
FL,
NV,
SC will join all other Aetna plans in using preferred pharmacy pricing in 2016. Other examples of plans moving to preferred pharmacy cost-sharing in 2016:
Comparing Preferred and non-Preferred Pharmacy Pricing
As an example, the chart below shows the variation between preferred and “non-preferred”
network pharmacies for the
2016 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 |
Non-Preferred |
Mail-Order |
Preferred Pharmacy |
Non-Preferred |
Mail-Order |
Initial Coverage Phase Cost-Sharing |
Tier 1 - Preferred Generic: |
$1.00 |
$3.00 |
N/A |
$3.00 |
$9.00 |
$0.00 |
Tier 2 - Generic: |
$2.00 |
$4.00 |
N/A |
$6.00 |
$12.00 |
$0.00 |
Tier 3 - Preferred Brand: |
$21.00 |
$31.00 |
N/A |
$63.00 |
$93.00 |
$58.00 |
Tier 4 - Non-Preferred Brand: |
30% |
40% |
N/A |
30% |
40% |
30% |
Tier 5 - Specialty Tier: |
25% |
25% |
N/A |
25% |
25% |
25% |
Note: The preferred and network pharmacy cost-sharing on the AARP MedicareRx Preferred plan
varies by state. You can use our
Rx$ 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 “non-preferred”
network pharmacies for the
2016 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 |
Non-Preferred |
Mail-Order |
Preferred Pharmacy |
Non-Preferred |
Mail-Order |
Initial Coverage Phase Cost-Sharing |
Tier 1 - Preferred Generic: |
$1.00 |
$10.00 |
$10.00 |
$3.00 |
$30.00 |
$30.00 |
Tier 2 - Generic: |
$7.00 |
$20.00 |
$20.00 |
$21.00 |
$60.00 |
$60.00 |
Tier 3 - Preferred Brand: |
$47.00 |
$47.00 |
$47.00 |
$141.00 |
$141.00 |
$141.00 |
Tier 4 - Non-Preferred Brand: |
50% |
50% |
50% |
50% |
50% |
50% |
Tier 5 - Specialty Tier: |
33% |
33% |
33% |
N/A |
N/A |
N/A |
Note: The preferred and network pharmacy cost-sharing on the First Health Part D Value Plus plan
varies by state. You can use our
Rx$ 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.
Preferred Pharmacy Cost-Sharing Example
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.
Bottom Line: you may pay more for your
medications at a “non-preferred” network pharmacy.
2016 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 plan |
$928 (P) |
$930 (P) |
$931 (P) |
$1,023 |
Symphonix Value Rx plan |
$1,080 (P) |
$1,081 (P) |
$1,104 |
$1,106 |
Symphonix PrimeSaver Rx plan |
$1,177 (P) |
$1,177 (P) |
$1,356 |
$1,203 |
Magellan Rx Medicare Basic plan |
$1,256 (P) |
$1,256 (P) |
$1,356 |
$1,301 |
AARP MedicareRx Saver Plus plan |
$1,310 |
$1,310 (P) |
$1,137 (P) |
$1,115 |
Cigna-HealthSpring Rx Secure-Extra plan |
$1,684 |
$1,120 (P) |
$1,127 (P) |
$1,100 |
*Annual Cost Estimates from Medicare.gov Plan Finder 10/26/2016.
(P) This is a preferred network pharmacy for the designated Medicare Part D plan
Bottom Line: If you want to lower your
2016 prescription drug costs, make sure you are using your plan’s preferred network
pharmacies (or, if available, the mail order option).