Understanding How Your Pharmacy Choice Can Affect Prescription Costs

Many people focus on premiums and deductibles when choosing a Medicare prescription drug plan, but the pharmacy you use can also affect how much you pay for medications.

If you have a Medicare Supplement plan, your prescription drug coverage typically comes from a standalone Medicare Part D prescription drug plan (PDP). These plans help cover the cost of prescription medications, but many people don’t realize that pharmacy choice can impact their out-of-pocket costs. Most Part D plans include both preferred pharmacies and standard pharmacies within their network.

You can fill your prescriptions at either type of pharmacy since both are considered in-network, but the cost of your medications may differ depending on which one you choose.

What Is a Preferred Pharmacy?

A preferred pharmacy is a pharmacy that has negotiated lower pricing with your prescription drug plan.

Because of these agreements, preferred pharmacies often offer:

• Lower copays for certain medications
• Better overall pricing on common prescriptions
• Lower coinsurance in some stages of the plan

Preferred pharmacies can include large national chains, regional pharmacies, or even some local independent pharmacies depending on the plan.

What Is a Standard Network Pharmacy?

A standard network pharmacy is still part of your plan’s network and can fill your prescriptions.
However, these pharmacies may have:

• Higher copays
• Slightly higher coinsurance costs

This means you can still use them, but your medication may cost more compared to a preferred pharmacy.

Can I Use Either Pharmacy?

Yes.

Both preferred and standard pharmacies are in-network, which means your prescription drug plan will still cover your medications at either location.
However, using a preferred pharmacy when possible may help reduce your out-of-pocket prescription costs. Many people continue using their regular pharmacy, especially if it is convenient. But depending on the plan and medication, it can be helpful to check whether your pharmacy is listed as preferred.

Example: Preferred vs. Standard Pharmacy Cost Difference

Below is an example using the Wellcare Value Script (PDP) plan available in Missouri. In this example we are comparing the cost of Atorvastatin, a commonly prescribed cholesterol medication.

Under this plan:

CVS is considered a preferred pharmacy
Walmart is considered a standard network pharmacy

Even though both pharmacies are in-network and can fill the prescription, the medication’s cost may differ depending on which pharmacy you use.

Walmart:

As the example above shows, the same medication can have different costs depending on the pharmacy you use. Even though both pharmacies are in-network, preferred pharmacies may offer lower copays for certain medications.How to Check If Your Pharmacy Is Preferred?

You can usually check if your pharmacy is listed as preferred by:

• Calling member services using the phone number on the back of your prescription drug plan ID card

• Logging into your member portal to review your pharmacy network

• Visiting your carrier’s website and searching the pharmacy directory

Because pharmacy networks can change each year, it’s a good idea to confirm this during your annual Medicare plan review.