Part D Preferred Pharmacies

I got a call from a client complaining about how her drug costs have gone way up, even though they are generics.  Her co-pays should not change during the year, so I did some research by putting her prescription list into the Medicare.gov Plan Finder.

Dina lives near a Safeway grocery store and has always used the pharmacy there.  But that store was bought by Haggen, a high-end grocer and a name I have never seen in the Medicare.gov Plan Finder.  Haggen took over the store in May and Dina  still uses the pharmacy – which is now run by Haggen.  I figured this the reason for her higher drug costs.

What are Part D Preferred Pharmacies?

As it turns out, Haggen is listed in the Medicare.gov Plan Finder but it is not a “preferred pharmacy” for her Part D plan. The Medicare.gov Plan Finder shows that she is paying higher prices because she is not using a “preferred pharmacy”.

All Part D plans now have “standard” and “preferred” pharmacies.  If you go to a preferred pharmacy, you pay the lowest-co-pays.  You pay more if you use a “standard” pharmacy.  If you go to a pharmacy that is not in your Part D plan’s network, you will pay the full retail price.

Dina has a “stand-alone” Part D plan because she uses Original Medicare and has a Medicare supplement.  To find the right plan for my clients, I put their prescriptions into the Medicare.gov Plan Finder.  The Plan Finder lists the 30 Part D plans available in Arizona from the most cost-efficient to the most expensive for the list of drugs I submit.

Putting in a list of drugs is not enough to find the “best” Part D plan for a person’s drugs because the Plan Finder requires me to put in a pharmacy.  If I choose Safeway as the pharmacy, I might not get the best results because Safeway might not be a “preferred pharmacy” for some plans. So I have to play around with the pharmacy choices to make sure I have selected a “preferred pharmacy”.

What a pain in the ……

As a broker, I do these searches every day and I get confused.  I can’t imagine how a person is supposed to use the Plan Finder on their own.  The Plan Finder is a good tool, but there is more to it than just putting in your prescriptions.

Dina asked me to call her doctor’s office to advise them about the grocery store that is two doors down from them. She said most of the doctor’s patients probably used the Safeway pharmacy and continue to use it now that it is owned by Haggen – and they are probably paying higher prices than they should.

Dina’s doctor is also my primary care physician, so I will send an email to her today.  When I go in for a check up, we usually talk more about insurance than my health.  The doctor always has questions about Medicare Advantage plans – and now we need to talk about Part D.

 

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2 Responses to "Part D Preferred Pharmacies"

  1. Reed says:

    This could also happen when CVS takes over Target’s pharmacy operations.
    http://www.bizjournals.com/twincities/news/2015/06/15/target-cvs-pharmacy-deal-losing-business.html

    In my Part C MA-PD plan, Target was preferred, but CVS is standard. ( I mainly use the plan’s mail order pharmacy).

    BTW, does your client’s plan not have a mail order pharmacy available ?

  2. Denise says:

    Good point about mail order. I should run her prescriptions and check mail order to see if she will save money. Part D plans used to give a nice discount for using their mail order, but that’s not the case any more. Though Humana still charges $0 for generics through heir mail order.

    You also reminded me that I was going to write about CVS and how they have been accused of overcharging people – or jacking up their prices so a person pays a co-pay that would be higher than the normal generic price.

    If the retail price should be $12, but the generic co-pay on a person’s plan is $15, CVS says the retail price is $16, so the customer pays the $15 co-pay. CVS makes a few dollars extra on each transaction this way.

    I have a client who ran into this problem with her ACA plan. I wrote about it last year.
    http://medicareblog.org/obamacare-drug-coverage-issues/

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