Key Takeaways

• Your access to prescription drugs under the PSHB Program in 2025 depends significantly on whether your preferred pharmacy is part of the plan’s network.

• Out-of-network pharmacy use can lead to higher out-of-pocket costs or even denial of coverage, so verifying network participation is critical.

Understanding the Role of Pharmacy Networks in PSHB

In 2025, the Postal Service Health Benefits (PSHB) Program replaces the previous FEHB system for USPS employees and retirees. With this shift comes new rules, new plans, and new provider networks—including pharmacy networks that may differ from what you were used to in 2024 and prior years.

Pharmacy networks under PSHB are crucial to how you receive your prescription drugs. Each PSHB plan contracts with specific pharmacies to create a preferred network. If your pharmacy is in that network, you typically receive medications at a lower cost and with fewer administrative steps. If it’s not, you might face higher costs or limited access to certain drugs.

Why Pharmacy Participation in the Network Matters

Choosing a pharmacy within your plan’s network is not just a recommendation—it’s a necessity if you want to avoid unnecessary expenses. Here’s why:

• Lower Copayments: In-network pharmacies offer negotiated pricing, which reduces your out-of-pocket costs.

• Access to Covered Drugs: Some medications may only be available through preferred pharmacies.

• Smooth Claims Processing: Claims are automatically submitted by in-network pharmacies, which reduces paperwork and billing errors.

• Compliance with PSHB Requirements: For those enrolled in Medicare Part D through PSHB, using a non-network pharmacy could mean your prescriptions aren’t covered at all.

What Changed in 2025?

2025 marks a significant transition with the implementation of PSHB. Here are the changes impacting your pharmacy access:

• Mandatory Shift to PSHB Plans: All USPS employees and retirees must use PSHB plans as of January 1, 2025.

• Part D Integration: If you’re Medicare-eligible, your PSHB plan includes a Medicare Part D prescription drug benefit. This coverage requires you to use network pharmacies for your drugs to be covered.

• Expanded Pharmacy Networks: Some plans have broadened their network to include major pharmacy chains and mail-order services, but others remain more limited. The only way to know is to check.

Steps to Check If Your Pharmacy Is in the Network

Finding out whether your preferred pharmacy is in-network doesn’t need to be complicated. Here’s how you can confirm:

1. Review Your Plan’s Pharmacy Directory: Every PSHB plan provides an updated list of participating pharmacies. This is typically available online or in your plan brochure.

2. Use the Plan’s Online Tool: Most PSHB plans have a pharmacy locator on their website. Enter your ZIP code to see nearby options.

3. Call Customer Service: If you’re unsure, a call to your plan’s customer service can confirm a pharmacy’s status.

4. Ask the Pharmacy Directly: Pharmacists can usually verify if they are in-network with your plan.

What Happens If You Use an Out-of-Network Pharmacy?

Using an out-of-network pharmacy can come with consequences that affect your healthcare budget and access:

• Higher Costs: You might have to pay full price for your prescription and submit a claim for partial reimbursement.

• No Coverage: Some plans may not cover out-of-network drugs at all unless it’s an emergency or no in-network pharmacy is available.

• Disruptions in Therapy: If you rely on a specific drug that is only covered when dispensed through a network pharmacy, using an out-of-network provider could interrupt your treatment.

Mail-Order Pharmacies: A Convenient Alternative

Many PSHB plans include mail-order options through their network. These services allow you to:

• Receive a 90-day supply of maintenance medications

• Avoid the hassle of frequent pharmacy visits

• Potentially lower your costs for long-term prescriptions

To use mail-order, your provider typically submits the prescription electronically, and your medication is shipped to your home within a few days.

PSHB and Medicare Part D: Why It Changes the Pharmacy Game

If you’re enrolled in Medicare and part of the PSHB Program, your prescription coverage runs through an Employer Group Waiver Plan (EGWP), which is a Medicare Part D plan. This means:

• You are subject to the Part D pharmacy network rules.

• The $2,000 out-of-pocket maximum introduced in 2025 for Part D plans applies only when using in-network pharmacies.

• Opting out of the drug plan under PSHB also opts you out of PSHB drug coverage altogether.

Given these stipulations, sticking with in-network pharmacies is even more critical.

Pharmacies and Specialty Drugs: A Special Note

Specialty medications used to treat complex conditions (such as cancer or autoimmune disorders) often require dispensing through specific specialty pharmacies.

• Not all in-network pharmacies are authorized to dispense specialty drugs.

• You may need to work through a plan-designated specialty pharmacy to ensure coverage and coordination of care.

• These pharmacies typically offer support services, such as patient education and 24/7 pharmacist access.

Check with your plan to verify which specialty pharmacy is in your network and what drugs must go through them.

Considerations for Rural or Underserved Areas

If you live in a rural area, your pharmacy options may be more limited. Here are a few tips:

• Check for Mail-Order Availability: This can help offset a lack of local in-network pharmacies.

• Look for Regional Chains or Independent Pharmacies: Some PSHB plans have agreements with smaller pharmacy networks.

• Request Network Exceptions: In some cases, your plan may grant an exception to allow a non-network pharmacy to count as in-network if no alternative is available.

Annual Plan Review: Why You Should Check Every Year

Pharmacy networks are not fixed. Plans change their agreements annually, so a pharmacy that was in-network in 2024 may not be in-network in 2025. That’s why it’s important to:

• Re-check the pharmacy list each Open Season (from November to December)

• Confirm that both your local and mail-order options are still covered

• Contact a licensed agent if you need help comparing plan pharmacy networks

Common Mistakes to Avoid

Avoiding simple errors can save you money and stress:

• Assuming Past Networks Still Apply: 2025 brought significant changes. Don’t rely on last year’s information.

• Overlooking Mail-Order Options: These can be more convenient and affordable for long-term prescriptions.

• Not Verifying Specialty Drug Coverage: Specialty medications require more detailed verification.

• Ignoring Annual Notices of Change: These letters outline what’s changing in your plan for the upcoming year, including network pharmacies.

Informed Choices Lead to Better Outcomes

Understanding whether your pharmacy is in the PSHB network isn’t just about convenience—it’s about ensuring uninterrupted care, minimizing costs, and fully using your 2025 benefits. Whether you’re actively working or retired from USPS, taking time to verify your pharmacy’s network status each year ensures you stay ahead of changes that could affect your care.

If you’re unsure how your current pharmacy fits into your PSHB plan or want help evaluating your options, speak with a licensed agent listed on this website for professional guidance.