Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION: I have used the same pharmacy for years, but my insurance is encouraging me to use a different pharmacy and mail order. Do I have to switch pharmacies?

 

ANSWER: Each year, insurance companies adjust their coverage, including pharmacy contracts. You may have decided to keep the same insurance product, but that does not mean your 2024 coverage is the same as it was last year.

During the Annual Open Enrollment period (October 15 to December 7), you have an opportunity to review your current insurance plan and decide on coverage for the coming year.

Open enrollment allows you to evaluate the insurance products available to help control costs. 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.

Many insurance companies own their own pharmacy or have a mail order option they strongly encourage enrollees to use. Those pharmacy options give you the lowest price on your medications.

The pharmacy list usually has two levels; standard & preferred. In 2024, there are plans that do not give you any prescription drug coverage at some pharmacy locations. So, pharmacy choice is always an important variable to include in your insurance plan selection.

When your pharmacy is a “Preferred Pharmacy,” you get lower pricing. When your pharmacy is a “Standard Pharmacy,” the pricing will be higher for you on each and every prescription. When your pharmacy is “Out of Network,” your prescription drug plan will not help you pay for any of the medications purchased there.

Are you willing to switch pharmacies? That is up to you. It is not that hard to do, but many of us choose our pharmacy because it is convenient, we like the people who work there, or it is close to where we 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 – aka the “Donut Hole” – sooner, causing your costs to increase significantly throughout the year.

You may want to consider mail order medications. This would mean your medications are delivered to where you get your mail. This can be arranged through a local pharmacy, like Wegman’s Home Delivery, which ships out of Buffalo. It could also be a national provider that your insurance company recommends. This information is included from the Evidence of Coverage for 2024, which you received at the beginning of the year. The mail order options could be a convenient way for you to get 90 day supplies of your regular medications.

Note that you can choose to receive some medications by mail and some medications at the local pharmacy you choose. It doesn’t have to be an all or nothing choice.

Talk to your pharmacist and see what they know. Some pharmacists are very familiar with insurance policies and may be able to explain some of the changes. Sometimes they don’t know the changes until they fill your prescriptions. You can review the material your insurance company sends to you for clarifications to the new rules. You can also contact your insurance company to ask these questions or for clarifications.

The www.medicare.gov website is designed to 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 into the pharmacy options available could save you a significant amount of money this year and beyond.

 

Read all Inside Medicare articles HERE.

 

LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, fill out the contact form below or call 716.849.1540.