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
A network pharmacy is a pharmacy contracted with a certain plan that allows members to get
their Medicare 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.
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.