One of the most common questions Medicare beneficiaries ask their agents is:
“How can I save money on my prescriptions?”
The answer often comes down to one key factor — where they choose to fill their prescriptions.
Why Pharmacy Choice Makes a Difference
When helping clients select a Medicare Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug Plan (MAPD), reviewing the plan’s formulary is just the start. To truly maximize savings, it’s just as important to understand the plan’s pharmacy network — especially which pharmacies are considered preferred.
Every plan includes a directory that lists pharmacies as either in-network or out-of-network. Clients should always use in-network pharmacies to avoid unnecessary out-of-pocket costs. But within that network, there’s another crucial distinction: preferred vs. standard pharmacies.
Preferred vs. Standard Pharmacies
Preferred Pharmacy
A preferred pharmacy is part of a plan’s network and offers members lower copays and coinsurance on certain prescription drugs.
For instance, CVS is a preferred pharmacy for Aetna. Their mail-order option, CVS Caremark® Mail Service Pharmacy, is also available in most states — offering clients both savings and convenience.
Standard Pharmacy
A standard pharmacy still belongs to a plan’s network but typically charges higher out-of-pocket costs than a preferred pharmacy.
If your client prefers a specific pharmacy, understanding their budget will help determine whether paying slightly more for convenience makes sense for them.
How Much Can Clients Save?
The difference in cost can be significant. Here’s an example for a Tier 1 generic drug:
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Preferred pharmacy: $3 for a 90-day supply
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Standard pharmacy: $18 for the same 90-day supply
That’s six times more for the exact same medication — simply because of where it’s purchased.
Helping Clients Make the Switch
Many beneficiaries continue using the same pharmacy for years, unaware they could save money by switching to a preferred location. Educating your clients about this option can make a big difference.
Most carriers offer pharmacy lookup tools that allow you to quickly identify which pharmacies are both in-network and preferred. These tools often include address details and allow searches by ZIP code, making it easy to compare options.
If your client is attached to their current pharmacy, you can also explore PDPs that list their local pharmacy as preferred. That way, they can keep their routine while still saving money.
The Takeaway
At your next client meeting, make sure to discuss pharmacy networks and explain how preferred pharmacies can stretch their healthcare dollars further.
Helping clients find simple ways to save — like choosing the right pharmacy — not only improves their satisfaction but also strengthens your long-term relationships.
Not affiliated with or endorsed by Medicare or any government agency.
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