Originally Posted by Andalusia
Insurance companies have a negotiated amount they will allow their customers to pay for a certain medicine if they get their prescription filled at an in-network pharmacy. This amount is negotiated by the PBM's. A pharmacy/pharmacist does not have to be an in-network provider for any insurance companies. Same goes for doctors, etc.

But you may not have many customers if you are not in-network with several insurance plans. If you agree to be an in-network pharmacy, then you have agreed to their reimbursement rates. So if the rates are not acceptable, then they should stop being an in-network provider.

This is how I understand it, but if I have any or all of it wrong please correct me.


It is very rare for us (independent pharmacies) to choose which plans we are preferred or non preferred in. The way it works is I choose a wholesaler (McKesson, cardinal or AmerisourceBergen) and they tell us who we are to be associated with. They do the negotiating and contract selection for us. It truly is a case of take it or leave it