Medicare requires each Part D drug plan to be sure that its Medicare enrollees have easy access to a local pharmacy that accepts the plan's insurance. Medicare drug plans may also offer a mail service option where you can get the medicines you take for a long period of time sent to your home.

Pharmacies

To get the best prices for their enrollees, drug plans usually set up contracts with a group of pharmacies. Those that give them the best prices will become part of the drug plan's preferred network of pharmacies. Some plans will also allow enrollees to use other pharmacies, but if they do, they may have to pay more out-of-pocket. These may be called non-preferred pharmacies. If you buy your drugs at a pharmacy that is neither a preferred nor non-preferred pharmacy, the plan may require you to pay the full cost of the drug. In other words, your Medicare drug card will not be accepted at that pharmacy. It helps to know which pharmacies work with your plan before you sign up for one.

Table 3: Where you buy your drugs will affect how much you pay

Medicare drug plans have different-sized pharmacy networks. Some plans, and all national drug plans (those offering Medicare drug coverage in all 50 states), include preferred pharmacies throughout the United States. But other drug plans offer coverage in only some regions of the country. Drug plans serving a smaller region may not contract with pharmacies outside of those areas. Unless you need your prescription in an emergency, you may have to pay the difference between the cost at a preferred pharmacy and the non-preferred pharmacy. An example of an emergency might be if you are traveling and run out of your medicine or if you become ill and cannot get to a network pharmacy. You may also have to pay the full retail price for the drug at the non-network pharmacy, and then fill out a claim form to be paid back by your drug plan.

Mail service

Many Medicare drug plans offer a mail service option that you can use instead of your local pharmacy. Mail service works best for medicines that you can wait a couple of days to have mailed right to your home. Mail service often costs less because plans tend to sell through mail at a lower price than you can get at local pharmacies. But, you usually have to buy in 60 or 90-day quantities, so you need to decide whether you can afford to buy in larger amounts at a time.

Mail service is best for drugs that you will be using for a long time, such as drugs that help you maintain health. Examples include drugs to treat diabetes, high blood pressure, and to lower cholesterol. Other drugs, such as tamoxifen, may also be taken for a long time to help keep cancer from coming back. These drugs are suited for mail delivery, too.

Some drugs that may seem to be good for mail service need special handling (such as refrigeration) which can take away the mail option. Mail service also may not be good for an antibiotic or other drug that you need right away, or for a drug you will be taking for only a short time. Your doctor should be able to help you decide whether mail service is a good option for your prescriptions.

Mail service may not be available under some Medicare drug plans. Or you may prefer to buy your drugs at a local pharmacy that is in your plan's network. You should know that plans vary on whether they allow you to fill prescriptions at a local pharmacy for more than a 30-day supply. Most plans will allow you to fill a 60-day supply; some will allow you to fill a 90-day supply. But plans with mail service options may encourage you to use the mail by offering a better price for a 90-day supply (or some other amount) through the mail than if you buy the drug at your local pharmacy.

Last Medical Review: 10/23/2008
Last Revised: 10/23/2008