There’s one thing Medicare clients ask their agents all the time: “How can I save money on prescription drugs? Let us help you answer that question!”
Let us help you answer that question by shedding light on the importance of pharmacy choice!
The Pharmacy Matters
Whether your client is enrolling in a stand-alone prescription drug plan (PDP) or a Medicare Advantage Prescription Drug (MAPD) plan, considering a plan’s formulary is only part of the decision. In order to save your clients money, it’s just as imperative to examine the preferred pharmacies for each plan.
When analyzing a plan, the directory will outline which pharmacies are considered in network and out of network. Spoiler — your clients will want to go to pharmacies that are within their plans’ network to avoid high out-of-pocket costs.
What Is a Preferred Pharmacy?
A preferred pharmacy is one that’s part of a Medicare drug plan’s network, in which the member may pay lower out-of-pockets costs for some prescription drugs.
For example, CVS is a preferred pharmacy for Aetna. Their mail order service, CVS Caremark® Mail Service Pharmacy, is also included in most states, so clients can conveniently order covered drugs through the mail.
What Is a Standard Pharmacy
On the other hand, a standard pharmacy refers to one that still participates in a plan’s network but charges a higher copayment or coinsurance than a preferred pharmacy.
It’s important to know your client’s budget. If their pharmacy is something they don’t want to give up, making room in the budget or knowing they can afford it can help them make the choice and stay happy!
Choose to Meet Clients’ Needs
Once you distinguish which pharmacies are in network, you should determine which of those pharmacies are preferred and standard.
Knowing the difference between these two and explaining it to your clients could lead to significant financial benefits.
Let’s use an example of Tier 1 generic drugs from one of our carriers.
For a 90-day supply at a preferred pharmacy, a member could pay $3.
For the same 90-day supply at a standard pharmacy, the member could pay $18. That’s six times more for the exact same product!
Making the Switch
Unfortunately, many members are unaware of these lower costs and just choose the same pharmacy they’ve been going to for years. If they knew there were options that could benefit them financially, they may be more inclined to switch pharmacies for the sake of savings.
Most carriers have a pharmacy look-up tool that helps people find pharmacies that are not only within their plans’ network, but also which ones are preferred.
Perhaps instead of your clients switching pharmacies entirely, the best course of action may be to find a PDP that includes their local pharmacy as preferred. This way, they can keep their day-to-day life the same while saving more money.
Most carriers have a pharmacy look-up tool that helps people find pharmacies that are within their plans’ network and preferred. Many of them will even show the exact address of the pharmacies and allow you to search by zip code.
With this information so readily at your fingertips, a little research can end up saving your clients a lot of money.
At your next sales appointment, be sure to start a conversation about preferred pharmacies with your clients. Saving your clients money in any way possible can satisfy your customers and build lasting relationships.
Our Ritter sales team can help you find plan directories and teach you how to use pharmacy look-up tools. They can also help you determine whether or not your client’s pharmacy is preferred.
Ritter is also here to help you educate and serve your clients. Register today to get started using our technology and resources!
Not affiliated with or endorsed by Medicare or any government agency.
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