What is the difference between a Preferred and Standard Pharmacy?

By January 12, 2021Newsletter

What is the difference between a Preferred and Standard Pharmacy?

Figuring out drug costs can make your head spin, even when you have already selected a plan! An easy way to ensure you are paying the best price for your medications it to use the correct pharmacy for your plan. The status of a pharmacy is dependent upon the contract the prescription drug plan (Part D) has with the pharmacy. Individual Part D plans can place a pharmacy (physical or mail-order) in 1 of 3 categories:

  1. Preferred
  2. Standard
  3. Out-of-Network

Preferred pharmacies will have the lowest copays and coinsurance, typically providing you with the most savings. Standard pharmacies are more expensive, but better than paying full price! Out-of-Network pharmacies want to be avoided if possible as you will pay 100% of the cost.

In some rare cases, the price of a medication may be cheaper at a standard pharmacy. But, this will ONLY occur if the retail price is cheaper than the copay of the medication. This is because pharmacies have some control over what the retail cost of a medication will be, so it is always a good idea to review your options when you are initially picking out a plan.

Also note that a Part D plan’s network can (and usually does) change every calendar year as contracts renew or terminate. Copays, coinsurance, monthly premiums, and the Tier of a medication also change every year. So, make sure you review your plan every year, but let us do the hard work for you!