When the copay is more than the drug

This page takes the 25 generic pills Cost Plus sells that Medicare drug plans filled most in 2024. Gabapentin, the fourth most-filled, is not on the Cost Plus price list. For each drug and each plan, it reads the copay for a 30-day supply at a retail pharmacy. It counts only the copay phase: tiers where the plan charges a flat copay and the deductible does not apply. For atorvastatin, that covers 88.5% of members.

In plans with a preferred network, the copay at a preferred pharmacy is more than the Cost Plus price for 0.0% of members (rounded) for every one of the 25 drugs. For each drug, at least 89.1% of the members in the copay phase pay $5 or less at the cheaper pharmacy type. Cost Plus does not beat that.

At a standard pharmacy in the same plans, the result changes. For all 25 drugs, the copay is more than the Cost Plus price for 20.9% to 30.3% of members. For atorvastatin, the most-filled drug in Part D, that is 21.0% of members, 6.3 million people. Of those, 95.0% are in one plan. Across the 25 drugs, that plan holds 65.9% to 95.0% of the members whose standard pharmacy copay is higher.

Members are 2026 members without Extra Help, moved to their 2027 plan by the CMS 2027 plan crosswalk. "Standard pharmacy" is an in-network retail pharmacy that is not preferred. A plan without a preferred network has one retail copay, counted here as the standard copay. The Cost Plus month is the smallest Cost Plus pack (30, 60 or 90 tablets) that covers the average month in Part D, from CMS dosage units and 30-day fills. For each drug, the strength shown is the most expensive of the usual Cost Plus strengths: those that plans holding 90% of members list, leaving out brand-labelled products and any product priced over twice the cheapest usual strength (a loading dose such as clopidogrel 300 mg). Both choices make Cost Plus look more expensive, not less. For potassium chloride, CMS counts liquid and powder forms in milliliters and grams, so the month cannot be read from the files; the page prices two tablets a day.

Wellcare Value Script is a stand-alone drug plan from Wellcare (Centene). It is sold as 34 regional plans, one for each Part D region. In 2026 it had 6.1 million members, and 5.9 million of them pay the plan's copays.

In 33 of the 34 regional plans for 2027, a tier 1 generic costs $0 for 30 days at a preferred pharmacy and $20 at a standard pharmacy. For 90 days it costs $0 at a preferred pharmacy, $0 by the plan's preferred mail order, and $60 at a standard pharmacy. One region, New Mexico, charges $15 for 30 days at a standard pharmacy. The deductible does not apply to tier 1. All 25 drugs in the table are on tier 1.

Wellcare Classic, the other Wellcare stand-alone plan, uses the same pharmacy network. Its tier 1 copay is $3 at a preferred pharmacy and $20 at a standard one, but the $700 deductible applies first. So its members pay the plan's own drug price until they meet the deductible, and the table counts them in the deductible group. Most Classic members have Extra Help: only 0.5 million pay the plan's copays.

The Value Script network has 53,599 retail pharmacies in its service areas. 27,512 of them, 51.3%, are standard. Wellcare Classic uses the same network: each of these pharmacies has the same status in both plans.

Store type decides most of it. Of the 24,076 independent pharmacies in the network, 21,441 are standard (89.1%). Of the chain pharmacies, 81.0% are preferred. Every CVS (8,269 stores) and every Walgreens (7,814) is preferred. Every Walmart (4,571) and every Sam's Club (569) is standard.

Store type and brand come from each pharmacy's NPI record in NPPES. "Chain" is a name rule in the Verzi Health data API; every other store counts as independent, so the independent count includes some hospital and clinic pharmacies. 575 network pharmacies have no NPPES match in the API. They are left out of the store-type counts, not of the totals.

Analysis 005 found 394 counties with exactly one pharmacy storefront. In the 2027 Value Script network, 340 of the 394 last pharmacies are standard, 34 are preferred, and 20 are not in the network. Of the 340, 332 are independent pharmacies and 4 are Walmart stores.

A Value Script member in one of those 340 counties has three choices for a month of a tier 1 generic: pay $20 at the local pharmacy ($15 in the 4 New Mexico counties), order 90 days by the plan's mail order for $0, or drive to a preferred pharmacy in another county. Cost Plus is a fourth: $11.20 for atorvastatin, delivered.

A cash purchase from Cost Plus is outside the plan. It does not count toward the plan's deductible or its out-of-pocket limit. For a tier 1 drug in Value Script, the deductible does not apply, so that matters little for these drugs. For a member who also takes expensive drugs, it can matter: cash spent on a generic does not bring the member closer to the out-of-pocket limit.

The plan's own mail order is $0 for 90 days on tier 1. For a member who can wait for the mail, that is cheaper than Cost Plus. The $20 copay is for the member who fills at the local store, month by month, and that store is standard.

• Plans, formularies, copays and pharmacy networks: CMS, Monthly Prescription Drug Plan Formulary and Pharmacy Network Information, contract year 2027 (release of October 8, 2026, posted October 15, 2026), read with the CMS record layout. Copays are for initial coverage, a 30-day supply, at retail pharmacies.
• Members: CMS, Low Income Subsidy Enrollment by Plan, 2026: enrolled minus Extra Help. The CMS 2027 plan crosswalk moves each 2026 plan's members to the 2027 plan that takes them. Members of 2026 plans that end (2.8 million) must choose a new plan and are not counted. Plans new in 2027 carry no weight. Members of Special Needs Plans (1.4 million) and of employer plans (9.1 million), which the public files do not cover, are left out.
• The 25 drugs: the generic lines in CMS Medicare Part D Spending by Drug (a generic name and its label, such as "Metformin HCl ER"), ranked by 2024 claims, that Cost Plus sells as a pill. A Cost Plus product joins a line through its RxNorm drug: the same ingredient, no conflicting salt, and the same release form. Cost Plus products without an RxNorm match in the API get one from the National Library of Medicine's RxNav, kept only when the strengths agree. Inhalers and short courses are left out. The month's supply uses 2023 dosage units per claim for the line and 30-day fills per claim for the drug (CMS Part D Spending by Drug and Part D Prescribers).
• Cost Plus Drugs prices: the public price list at costplusdrugs.com, captured as dated, change-only snapshots by the Verzi Health data API, and checked live on the release date. For 30 tablets, or a weekly pack of 4, the price is the listed price. For 60 or 90 tablets, it follows Cost Plus's published formula: cost per tablet, times 1.15, times the tablets, plus the $5 pharmacy fee. Every price adds $5 shipping. Each product is matched to its RxNorm drug, and the build checks that the strength matches.
• Pharmacy store type: NPPES, through the Verzi Health data API (/rx/pharmacies).
• The build checks that this page states each figure it produces. Any mismatch stops the build.

What this can and cannot say. It describes plan design, the copays each plan files with Medicare, not what any member paid. Members are weighted by 2026 enrollment, and members can change plans for 2027. The page does not price coinsurance tiers or the deductible phase, because the 2027 files do not carry plans' drug prices. In atorvastatin's case, 11.5% of members are in a plan where the deductible applies to it. Nothing here describes the quality of any plan, pharmacy or drug, or the conduct of any company.

Each figure group on this page, with its source, a link to the public original and a link to a copy kept next to this page. The copies are CSV extracts of the exact rows the build reads from the CMS files and from the Cost Plus price list. The build fails if a figure on this page has no receipt, or if a copy differs from the data.