December 16, 2014

Medicare prescription drug plans typically include nearly all available pharmacies in their networks. For national plans, this means beneficiaries can use their insurance at some 64,000 pharmacies across the country.

In 2015, nearly 9 out of 10 Medicare Part D prescription drug plans will also give beneficiaries the option of using a “preferred pharmacy” to lower their out-of-pocket costs. Beneficiaries enrolled in these plans can still get their prescriptions filled at virtually any pharmacy but also have the option of using a lower-cost preferred pharmacy.

As the Centers for Medicare and Medicaid Services (CMS) and other policymakers consider pharmacy access, the Pharmaceutical Care Management Association (PCMA) commissioned Visante to examine how close Medicare beneficiaries live to preferred pharmacies and how much they can save by using them. To do this, Visante relied on geospatial data supplied by Quest Analytics, whose software is widely used to evaluate pharmacy network adequacy. Visante also used Part D data published by CMS, the Kaiser Family Foundation, and major actuarial firms.

Read the full study.

Major Findings:

  • In urban and suburban areas, the average Medicare beneficiary need only travel about one extra mile to use a preferred retail pharmacy to save $20-$40 on monthly cost sharing or can save even more with no travel by using a mail-service pharmacy.
  • In rural areas, the average Medicare beneficiary can travel about 4 miles to use their closest pharmacy or, at their option, can travel an additional 4 miles to use a preferred pharmacy and save $20–$40 per month on copays or can avoid travel and save more by using mail order.
  • Medicare beneficiaries can use their insurance at nearly all independent pharmacies, nearly all chain pharmacies, and nearly all pharmacies located in supermarkets, big-box retailers, and wholesale clubs.

Preferred and mail-service pharmacies not only reduce out-of-pocket expenses for beneficiaries, other research indicates that overall average prescriptions costs are less through preferred pharmacies and that Part D plans offering preferred pharmacy options have lower average premiums.

In short, Medicare beneficiaries typically have access to nearly all pharmacies as well as the option of using a convenient preferred retail pharmacy or a mail-service pharmacy to save themselves and the Medicare program money.