Sixty-Five Incorporated

Unbiased Medicare Help: (262) 223-3433

SFDA6242013-article-corner-pharmacy-may-not-be-your-best-deal.jpg

The Corner Pharmacy May not Be
Your Best Deal

Here’s a new situation those with a Medicare Part D prescription drug plan might encounter. 

Can you tell me why the same prescription medication doesn’t cost the same at every pharmacy? I usually get this medication at the corner drug store. However, I was visiting my daughter for a few days and dropped a refill order at the pharmacy by her house. I was surprised to find it cost $10 less at that place. I thought if the pharmacy was in the network, it would cost the same no matter where I went. 

Medicare beneficiaries with a Part D prescription drug plan know about network pharmacies. The plan (whether it is a stand-alone or part of a Medicare Advantage plan) has a contract with pharmacies. Beneficiaries must use these pharmacies in order for the plan to cover the medications. 

The game has changed. Now, pharmacies can offer two types of cost sharing. The first is standard retail cost-sharing. This is sort of the basic network pricing.

The second are pharmacies that offer preferred retail cost sharing, formerly called preferred pharmacies. Plan members can save money by using them. The copayment or coinsurance can be less simply because this pharmacy has agreed to charge less for plan members. Not every plan offers this extra benefit. However, the number of drug plans offering preferred retail cost-sharing has increased from 7% to over 85% in recent years. 

Last updated: 08-28-2018