Medicare Part D Pharmacies

True or false: When you enroll in Medicare prescription drug coverage, it doesn’t matter which pharmacy you visit to get your prescriptions filled.

The answer: FALSE.

Pharmacies not only play a major role in your prescription drug costs after you enroll in a plan, they’re also an important part of the decision-making process for choosing a plan. The pharmacy where you choose to have your prescriptions filled can have a direct impact on the overall out-of-pocket expenses you end up paying for your prescription drugs. That’s why the network pharmacies for different plans matter.

Network Pharmacies

A network pharmacy is a pharmacy contracted with a certain plan that allows members to get their prescription drug benefits at a contracted cost. Generally, your prescription drugs will only be covered if they’re filled at a plan’s network pharmacy.

A plan can decide which pharmacies it has in its network. This is why it’s important to look into which pharmacies are in a plan’s network before enrolling in a plan. If you have a favorite pharmacy that you prefer over any others, you’ll want to make sure that pharmacy is included in your potential plan’s network so you can keep your prescription drug costs as low as possible.

Out-of-Network Pharmacies

An out-of-network pharmacy does not contract with a specific plan to coordinate or provide covered drugs to members of the plan. Most drugs you get from out-of-network pharmacies are not covered by the plan unless certain conditions apply.

If your favorite pharmacy is out-of-network, and you don’t want to change your pharmacy to one that is in network, you will pay higher out-of-pocket expenses for your prescription drugs. It is recommended that you avoid out-of-network pharmacies for this reason.