Part D Pharmacy Networks
•Part D coverage is generally provided through contracted pharmacies (network pharmacies) in the Part D plan’s service area, except that PFFS plans are not required to use a pharmacy network but may voluntarily choose to have one.
•Network pharmacies include retail pharmacies and may also include mail-order pharmacies.
•Within their networks, Part D plans may designate some pharmacies as preferred pharmacies that offer lower levels of cost-sharing (“preferred cost-sharing”) than apply at other network pharmacies (“standard cost-sharing”).
•Enrollees are generally required to fill prescriptions for covered drugs at network pharmacies.
•Under certain circumstances, enrollees may fill prescriptions for covered drugs at out-of-network (non-network) pharmacies, but possibly at a higher cost to enrollees. For example:
If the enrollee has an illness or loses a drug while traveling outside the service area; or
If circumstances result in limited drug access through an in-network pharmacy
| Part D Network Part D Pharmacy Networks •Part D coverage is generally provided through contracted pharmacies (network pharmacies) in the Part D plan’s service area, except that PFFS plans are not required to use a pharmacy network but may voluntarily choose to have one. •Network pharmacies include retail pharmacies and may also include mail-order pharmacies. •Within their networks, Part D plans may designate some pharmacies as preferred pharmacies that offer lower levels of cost-sharing (“preferred cost-sharing”) than apply at other network pharmacies (“standard cost-sharing”). •Enrollees are generally required to fill prescriptions for covered drugs at network pharmacies. •Under certain circumstances, enrollees may fill prescriptions for covered drugs at out-of-network (non-network) pharmacies, but possibly at a higher cost to enrollees. For example: If the enrollee has an illness or loses a drug while traveling outside the service area; or If circumstances result in limited drug access through an in-network pharmacy. |
