New Plans Could Mean New Pharmacies In 2018

Question: When evaluating my insurance options, I changed my plan for 2018. That will require me to switch my pharmacy to save even more money. How do you recommend making my medications switch to the new pharmacy?

Answer: One of the changes that I noticed in working with individuals on finding the best Prescription Drug plans for them, is that many of the plans made significant changes to their pharmacy standards for 2018. What this means to you is that whether you switched your Part D coverage or not, you should be reviewing the pharmacy you use.

There are two types of pharmacy pricing contracts; the first is Standard and the second is Preferred. For you as a consumer, that results in a difference in the price you pay when you pick up the medications. If your Part D plan has two different contract types, it will be listed in the material they sent to you. When an insurance company negotiates pricing, the Preferred Status contract saves you money.

For 2018, we found that many plans adjusted this Standard and Preferred Status for the pharmacies in the area. Previously, there were a number of plans that gave you the exact same pricing structure no matter what pharmacy you used. This Standard pricing contract means you can use any pharmacy and be comfortable with your costs. In 2018, there are not any Stand Alone Drug Plans that are doing that. They all have some cost differences between the Standard and Preferred Pharmacy list. In some situations, the price difference is significant.

For those plans that in the past had a different pricing structure for different pharmacies, those Preferred Pharmacies may have changed. Mostly the plans have expanded the Pharmacies that are Preferred Pharmacies. For example; you may pay full price for Tier One and Tier Two medications at a Standard Contract Pharmacy, but if you use a Preferred Pharmacy those Tier One medications would be $1 for a 30-day supply and those Tier Two medications would be $6 for a 30-day supply. This price difference can be significant, or it can be only pennies, depending on the cost of the medication.

You may also find that the pharmacy you are using is now a Preferred Pharmacy, so you don’t need to change your pharmacy choice.

You can determine your pharmacy status by reviewing the information mailed to you in your packet for 2018. The booklet includes information regarding pharmacy status. You can also contact your plan directly, by calling the contact numbers on the back of your insurance card. A third option is to review the website information for your insurance product. All plans now have a presence on the web where you can access information regarding pharmacy contacts and also formulary information (list of drugs they cover). Using one of these three tools is a great way to determine where you can save the most money on the cost of your medications.

There are some plans that in 2018 did not change the pharmacy pricing structures.

I am NOT recommending you switch pharmacies. I am recommending you review the information from your insurance company to determine if you can save money, and evaluate how much money you can save. If switching makes sense for you and you want to do it, you certainly can.

The second part of this question, was “How do I make the switch?”

One thing to consider is “When to make the switch?” You don’t need to rush out and do it today. Your new plan won’t start until Jan. 1, 2018. There is a lot to do this time of year and the doctor’s offices will be closed for some of the holidays. It may make sense to wait until after Jan. 1 to begin making those requests. It also depends on your medication supply. You don’t want to run out of medications.

There are some pharmacies that will do the work for you. If you bring them a list of your medications and the physicians who prescribed them, the pharmacy will reach out to get the necessary scripts to begin filling your medications there. This service is usually highly advertised by the pharmacy.

In other situations, you will need to contact your physician’s office and request that your medications be sent to your new pharmacy. This contact can be done via a phone call or through a patient web portal, using your computer link. In making this contact, please remember that this is not usually done the same day you request it. Most doctor offices say it takes at least two days. So be sure you have enough medication to get you through at least a week. Also, be sure you are contacting the correct physician to make this request. Many individuals get their medications prescribed from multiple doctors. For example, your primary care handles some, your cardiologist handles others, and your urologist handles yet another list. This will require you calling multiple offices to request the pharmacy switch. This isn’t hard to do, it just needs to be organized.

You also want to be sure that you are taking the medications they are calling in. People do not always take all the medications that their doctor prescribes. You must report to your doctor at each visit what you are taking so they have accurate records, but that may have changed since you were there last time.

So you may want to specify in that request what medications you want filled.

You also want to be sure that you are getting the correct amount of medication. Some people like to receive a 90-day supply and others like a 30-day supply better. Be sure that when contacting your physician you make your preference known. Many of the prescription drug plans give you a discount when you buy a 90-day supply. This can also save you money. But it also means a bigger payout each time when you pick up the medication. A 30-day supply at $47, could be $141 for a 90-day supply. Sometimes that bigger expense is hard to budget.

When individuals have EPIC, the New York State benefit, we often encourage 90-day supplies. If you spend enough on your medications to benefit from EPIC, those 90-day supplies do save you more. If you have EPIC with a high deductible, you may never spend enough at the pharmacy to reach your EPIC deductible.

You can decide what works better for you. A 90-day supply may be a bigger payout each time you go to the pharmacy, but you may not have to go as often.

I know that many people already go to the pharmacy they prefer. They are very loyal to and happy with their current pharmacy. Others switch pharmacies easily and are comfortable with that change. I am NOT recommending switching pharmacies if you like where you are going. I am recommending reviewing the choices, and if it will save you money, you can decide if it is enough money to switch pharmacies. You may be surprised that the price difference is not a lot and therefore not as important to change. You also may be pleasantly surprised to determine the pharmacy you use is the best pricing structure for you.

I always want you to be an informed consumer. Once you have the information you need, you can decide how you make your decision and where you should be going for your medications.

Wishing you all the best for 2018. I think it will be another GREAT year!

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at