One of the most common questions Medicare clients ask is: How can I save money on my prescription medications? As their trusted advisor, you’ll want to be prepared with the right answers.
When guiding your clients through the process—whether they’re enrolling in a stand-alone Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug (MAPD) plan—reviewing the plan’s formulary is only part of the equation. To help them maximize savings, it’s equally important to consider the plan’s preferred pharmacy network.
Choosing a plan with access to cost-effective, preferred pharmacies can make a significant difference in your clients’ out-of-pocket expenses. Knowing how to navigate these details will ensure you provide even greater value to the people you serve.
Understanding Preferred vs. Standard Pharmacies
A preferred pharmacy is part of a Medicare drug plan’s network where members enjoy lower out-of-pocket costs for certain prescription medications.
In contrast, a standard pharmacy also participates in the plan’s network but typically charges higher copayments or coinsurance compared to preferred pharmacies.
When evaluating a plan, the pharmacy directory will indicate which pharmacies are in-network or out-of-network. It’s essential for your clients to use in-network pharmacies to avoid excessive out-of-pocket costs.
But there’s another critical step: Once you identify in-network pharmacies, it’s important to distinguish between preferred and standard pharmacies. Knowing these differences—and explaining them clearly to your clients—can help them save a significant amount of money on their prescriptions.
Put It into Practice
Here’s a simple example using Tier 1 generic drugs from one of our carriers. For a 90-day supply at a preferred pharmacy, a member might pay just $3. At a standard pharmacy, that same 90-day supply could cost $18—six times more for the exact same medication!
Unfortunately, many clients stick with the pharmacy they’ve always used, unaware that switching to a preferred pharmacy could significantly reduce their costs. If your clients knew they had cost-saving options, they’d likely be more open to making a change.
In some cases, the best solution isn’t switching pharmacies at all but instead finding a Prescription Drug Plan (PDP) that lists their current pharmacy as preferred. This allows them to maintain their routine while enjoying substantial savings.
Use Carrier Tools to Help Clients Save
Most carriers offer pharmacy look-up tools that allow you to search for in-network and preferred pharmacies by zip code. These tools often provide exact addresses, making it easy to identify nearby pharmacies where your clients can save the most money.
Take the Extra Step
At your next sales appointment, start the conversation about preferred pharmacies. Your Essential Care sales specialist can guide you through plan directories, teach you how to use pharmacy look-up tools, and help confirm whether your client’s pharmacy is preferred.
Helping your clients save money is one of the best ways to build trust and long-lasting relationships—while improving their overall experience with you as their agent.
Not affiliated with or endorsed by Medicare or any government agency.
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