Where you fill a prescription can change what you pay for it — even when both pharmacies are in your plan's network.
Medicare prescription drug coverage comes in two forms: a stand-alone Part D plan that works alongside Original Medicare, or a Medicare Advantage plan that includes drug coverage (often called an MA-PD). These plans have a network of pharmacies — and most split that network into two tiers.
Preferred vs. standard pharmacies
Preferred pharmacies
Lowest out-of-pocket costs
These pharmacies have agreed to lower prices with your plan, and they pass those savings to you through lower copays or coinsurance on covered drugs.
Standard pharmacies
Higher out-of-pocket costs
Also in-network, so your plan still covers your drugs here. But your share of the cost is higher than at a preferred pharmacy for the very same prescription.
The difference can add up quickly if you take several medications every month. Which pharmacies are preferred varies from plan to plan, so a pharmacy that is preferred under one plan may be standard under another.
Same drug, same plan, same network — and a different price at the counter, depending on which door you walk through.
How to keep your drug costs as low as possible
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Look up your pharmacy's status
Check your plan's pharmacy directory to see whether your current pharmacy is preferred, standard, or out-of-network. Out-of-network pharmacies may not be covered at all.
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Consider mail order
Many plans offer mail-order service with lower costs, and often a 90-day supply instead of 30. It is a good fit for maintenance medications you take every day.
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Ask about generics
Generic drugs usually sit in lower cost tiers than brand names. Ask your doctor whether a generic or lower-tier alternative would work for you.
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Confirm your drugs are on the formulary
Every plan has a list of covered drugs. Make sure each of your medications is on it, and note which tier it falls in and whether any approvals are required.
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Review your plan every year
Plans can change their pharmacy networks, formularies, and costs each year. Use the Annual Enrollment Period, October 15 to December 7, to compare options against your current medications and pharmacy.
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See if you qualify for extra help
Medicare's Extra Help program can lower premiums and drug costs for people with limited income and resources. Medicare also caps yearly out-of-pocket drug spending, and a payment program can spread those costs across the year.
Not sure which plan and pharmacy combination is best for your medications? We can compare plans side by side with your prescription list — at no cost to you.
