What does "preferred" really mean?

"Preferred" indicates a low risk level of your patient leaving your pharmacy for another pharmacy. If the patient is enrolled in a preferred plan their plan won't advertise that they can get cheaper copays if they fill their medications elsewhere. In reality, most patients would save very little by going to a preferred pharmacy.

During Open Enrollment your patients will receive letters from their insurance plan informing them if their pharmacy (you) will no longer be preferred in the upcoming year. The message portrayed in the letter can be misleading -- your patients might conclude they’re being required to fill at a different, preferred pharmacy. Ultimately the plans wants to ensure the patient doesn't enroll in a different plan, so they will try to push the patient to a preferred pharmacy. 

How does a preferred plan impact out-of-pocket cost?

The preferred status of a plan is only one contributing factor of a patient's out-of-pocket cost with a plan. Oftentimes the cheapest plan for the patient is not a preferred plan.

A plan that's non-preferred (standard cost share) / mail-order or chain preferred can still be a cheaper option for the patient even though it's not preferred, just simply based on the plan's formulary, which impacts overall cost the most:

  • What drugs are covered on the plan's formulary
  • What the set or percentage-based copays are for each drug tier 
  • What the drug full costs are

Amplicare takes into account all of these factors and simplifies the information to make comparing plans much more streamlined.

What's Next?

Review these talking points on how to discuss mail-order preferred plans with your patients!

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