Typically, not all plans are accepted at the pharmacy.

Your pharmacy is probably contracted with some plans and not others. This is often handled by PSAOs, who work with plan providers to offer groups of in-network plans to their members. An out-of-network plan is one that your pharmacy is not contracted with. This means a patient would have to pay over the counter prices, because their medications aren't covered at your pharmacy.

Amplicare only shows in-network plans. 

Out-of-network plans don't offer benefits to patients filling at your pharmacy. Since this would likely lead to patients leaving your pharmacy for one that is in-network with their plan, Amplicare Match (iMedicare) does not show out-of-network plans for your pharmacy. This is one way plan comparisons help your patient retention.

In-network does not mean preferred.

You can be in-network with non-preferred plans. In these instances, you accept the plan, but a preferred pharmacy might offer lower out-of-pocket costs to the patient. That said, it's still wise to perform a plan comparison because non-preferred isn't necessarily more expensive (especially when copays are subsidized, as is the case for many low income patients).

But... 

Using Amplicare's Select Nearby Pharmacy function on the plan comparison page, you can see what plans are in-network with other pharmacies, and estimate patient costs with those plans. 

What's Next?

Are you wondering if a patient can still enroll in an out-of-network plan? Refer to this article!

Did this answer your question?