Members may have reduced cost-share amounts on certain formulary tiers when utilizing preferred pharmacies. Is this statement true or false?

The statement is true. Many Medicare Advantage plans, including those offered by Anthem, often provide members with reduced cost-share amounts on certain formulary tiers when they use preferred pharmacies. This arrangement is designed to encourage members to utilize specific pharmacies that have an agreement with the plan to offer lower prices on medications.

Preferred pharmacies typically have negotiated rates with the health plan, which can result in lower out-of-pocket costs for members on their prescription medications. This practice serves to not only benefit the members through reduced costs but also helps the insurance company manage its expenses more effectively by directing members to pharmacies that align with their pricing strategies.

The concept of reduced cost-share is applicable not only to generic drugs but often extends to brand-name drugs as well, depending on the specific formulary structure of the plan. This incentivizes members to choose preferred pharmacies, which in turn can lead to more streamlined medication management and potentially better health outcomes.