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New Report: Drugstore Networks Could Save Employers, Medicare, and Medicaid $115 Billion
Date:1/28/2013

harmacy access standards.
  • Medicaid: $26 billion
  • Medicare savings: $35 billion
  • Commercial sector savings: $54 billion
  • Total savings: $115 billion
  • Pharmacies as common as fast food restaurants. Today, there are more drugstores in the U.S. than McDonald's, Burger Kings, Pizza Huts, Wendy's, Taco Bells, Kentucky Fried Chickens, Domino's Pizzas, and Dunkin' Donuts combined, creating a highly competitive environment.
  • Three types of retail pharmacy networks include:

    • Open Pharmacy Network.  Plans create a broad network open to virtually all drugstores that agree to offer basic discounts to the plans. A plan's enrollees can use their prescription drug benefits at all network pharmacies for the same copay/cost share.  This is currently the most widely used type of retail pharmacy network.
    • Preferred Pharmacy Network.  Plans create a select group of preferred pharmacies within a broader network of non-preferred drugstores.  Preferred pharmacies offer plans better discounts than the non-preferred drugstores, and plans, in turn, lower copays/cost sharing for enrollees who choose them.  Use of preferred networks is growing and can lower prescription costs by an estimated 5%, compared to open networks, while meeting Medicare's pharmacy access standards nationally.
    • Limited Pharmacy Network. Plans create a network limited to drugstores that offer deep discounts.  Plan enrollees have the same copay at all pharmacies in the network.  Compared to open networks, limited networks can lower costs by up to 10% or more.

    Despite the growth and popularity of pharmacy networks, some public policies undermine their use in Medicaid, Medicare, and the commercial sector.

    • "Any Willing Pharmacy"
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    SOURCE Pharmaceutical Care Management Association
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