How Close Should Your Pharmacy Be?

The question of limited networks continues to be a hot topic with mandatory mail, Maintenance Choice, Restat’s Align, Humana / Walmart, and OptumRx’s new Value Network.  So, the core question is what are reasonable expectations for access. 

Most people look to the “TRICARE access standard” which the Department of Defense uses:

  • 90% of the members in an urban area must live within 2 miles of a pharmacy
  • 90% of members in a suburban area must live within 5 miles of a pharmacy
  • 70% of members in a rural area must live within 15 miles of a pharmacy

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