I received my 2020 plan details and my pharmacy is now ‘a standard pharmacy’. The plan information recommended I switch to one of the ‘preferred pharmacy’ options. What is the difference?
This is a popular question this year. In the Medicare Insurance options for 2020 we have seen a lot of pharmacy changes. You may have decided to keep the same insurance product, but that does not mean your coverage is the same as it was last year.
The “Participating Pharmacies” is one of the changes made to a lot of plans for 2020. Plans may have switched the pharmacies that give you the lowest price. Each year during open enrollment we have an opportunity to review our current insurance plan and how it will alter what we do in the new year. The pharmacies have two levels; standard & preferred. There are very few situations where your pharmacy would no longer be participating at all.
You have read my articles enough to know that I always recommend evaluating your decision every year. Participating Pharmacy is certainly part of this evaluation process.
When your pharmacy is a ‘Preferred Pharmacy’, you get lower pricing and often are allowed to get 90 day supplies of your medications. When your pharmacy is a ‘Standard Pharmacy’ the pricing will be higher for you on each and every prescription. You also may not be allowed to get 90 day supplies of your medications.
Are you willing to switch pharmacies? That is up to you. It is not that hard to do, but many of us choose the pharmacy we have because it is convenient, you like the people who work there, or it is close to where you work or live. If you have to drive across town to save some money, will you be happy with that choice? How often do you have to drive there? Will you be saving money if it is out of your way?
The negotiated cost of your medications can also be very different from pharmacy to pharmacy with the same insurance product. If your negotiated cost is higher for your medication, you could hit the coverage gap (Donut Hole) sooner, and then your costs could increase significantly.
You may want to consider mail order medications. This would mean your medications are delivered to you, where you get your mail. This can be arranged through a local pharmacy, like Wegman’s mail order, which ships out of Buffalo. It could also be a national provider that your insurance company recommends. This information would be included in the material they send you, the Explanation of Benefits for 2020 you just received. This could be a convenient way for you to get 90 day supplies of your regular medications.
You could do some medications mail order and some medications at the local pharmacy you choose. It doesn’t have to be an all or nothing choice.
I know that many people don’t like change all that much. This Medicare Open Enrollment Period allows you to evaluate the insurance products available each year to help control costs. Sometimes that evaluation process then requires a decision to change or not to change to save that money. Only you can decide when and how much change makes the savings worthwhile.
I have heard on more than one occasion, “I don’t care what it costs I won’t change ________.” You fill in the blank, doctor, pharmacy, medication, hospital, whatever. Sometimes that is “the line in the sand”. Maybe for you switching to another pharmacy isn’t such a big deal and it could save you some money on your medications.
Talk to your pharmacist and see what he or she knows. Some pharmacists are good at talking about insurance; and may be able to explain some of the changes. Sometimes they don’t know the changes until it pops up on the computer screen as they fill your medications. You can review the material your insurance company sends to you, as you did, for clarifications to the new rules. You can also contact your insurance product to ask these questions or for clarifications.
The www.medicare.gov website and tools there help you through this research. The information on the website is very useful. If you don’t use a computer, maybe someone in your family could work with you on this.
The 1-800-medicare call center staff can also help you evaluate this information. As you mentioned, your current plan has sent you information on pharmacy changes and co-pay structures as well. So review that material and use the resources to research the options. This research could save you a significant amount of money in 2020.
To contact Janell Sluga with questions or concerns, call 716-720-9797 or e-mail her at email@example.com.