Medicare and Mail-Order Prescriptions
This article was updated on: 09/12/2018
Many people appreciate the convenience of using mail order prescriptions with their Medicare Part D prescription drug coverage. If you currently use a mail-order prescription service or are considering a mail-order pharmacy, here’s what you should know.
Does Medicare cover mail-order prescriptions?
Medicare Part D coverage for prescription drugs is offered through private insurance companies approved by Medicare to provide this coverage. It is available in two ways:
- A stand-alone Medicare Part D Prescription Drug Plan to complement your coverage under Original Medicare, or
- A Medicare Advantage Prescription Drug Plan.
Because these plans are provided through private insurance companies, each plan has its own rules about using a mail-order prescription drug service. Some plans may offer lower copayments or deductible amounts for purchasing up to a 90-day supply of your prescription medications through a preferred mail-order prescription provider.
Your prescription drug coverage may include certain cost-saving requirements, depending on the plan you choose and the prescription medication your doctor orders, which may include:
- Prior authorization from the insurance company before a prescription is filled.
- Quantity limits for how many doses of a prescription medication you can get at one time or during a particular time period.
- Step therapy that requires you to try a lower priced prescription medication before the plan will pay for a higher priced one.
It’s important to check your individual plan information booklet to see how it covers mail order prescriptions.
Are there any Medicare restrictions on mail-order prescriptions?
Many people enrolled in Medicare Part D coverage for prescription drugs use an automatic refill service with their mail order prescriptions which allowed the pharmacy to automatically send your prescription medications when you’re about to run out. Although this is convenient for many people, too often, the mail order pharmacy was sending prescription medication enrollees no longer wanted or needed.
In order to cut down on waste and unnecessary costs, Medicare enacted a new policy for mail-order prescriptions. Now the pharmacy must contact you before sending the prescription medication to get your approval unless you contact them first to authorize the next delivery. If you get unauthorized or unwanted prescription medications from a mail-order pharmacy, you may be able to get a refund for the prescription medications. Call 1-800-MEDICARE if you have concerns about unwanted mail-order prescriptions.
This policy doesn’t affect prescriptions you pick up at the pharmacy that are automatically refilled. It also doesn’t apply to pharmacies in long-term care facilities.
Still have questions about Medicare and mail order prescriptions?
If you still have questions about mail order prescriptions or Medicare Part D coverage for prescription drugs, I am happy to help you find answers. If you prefer, you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about plan options in your area by clicking the Compare Plans button.