Medicare Part D: Things People With Cancer May Want to Know

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Where can I use my Part D drug coverage to fill my prescriptions?

Medicare requires that each Part D drug plan be sure that its Medicare enrollees have easy access to a local pharmacy that accepts the plan. Medicare drug plans may also offer a mail service option so you can get the medicines you will take for a long time sent right 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 allow you to use other pharmacies, but if they do, you may have to pay more out-of-pocket. These may be called non-preferred pharmacies.

If you buy your drugs at a pharmacy that’s 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’s a good idea to know which pharmacies work with each plan before you sign up for one.

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

    Type of pharmacy

    Will my drugs be covered by my Medicare drug plan?

    Community (local) pharmacy

    Preferred network

    Yes, with the plan’s usual cost-sharing amounts

    Non-preferred network

    Yes, but you may pay more than the plan’s usual cost-sharing amounts

    Non-network

    No, you will have to pay the full cost of the drug

    Mail service pharmacy

    Preferred network

    Yes, with the plan’s usual cost-sharing amounts

    Non-preferred network

    Yes, but you may pay more than the plan’s usual cost-sharing amounts

    Non-network

    No, you will have to pay the full cost of the drug

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 only cover some regions of the country.

Drug plans serving a smaller region may not contract with pharmacies outside of those areas. If 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 don’t need right away, which can be mailed right to your home. Mail service often costs less because plans tend to sell through the mail at a lower price than local pharmacies charge. But you usually have to buy in 60- or 90-day quantities, so you need to decide whether you can afford 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 stay healthy. Examples include drugs to treat diabetes, high blood pressure, and drugs that are taken for a long time to help keep cancer from coming back, like tamoxifen.

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 might prefer to buy your drugs at a local pharmacy 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) than if you buy the drug at your local pharmacy.


Last Medical Review: 01/22/2014
Last Revised: 01/23/2014