Got Questions About Part D Drug Coverage And Pharmacies? Here Are Some Answers

The Medicare Open Enrollment Period is over. It seems as though every beneficiary I spoke with during the last two months had questions about one topic: pharmacies. So, here are answers to 10 frequently asked questions about Part D drug plans and pharmacies.

What pharmacies can I use?

Medicare requires Part D drug plans to have a network of pharmacies. Your plan will cover medications that you get from these pharmacies. If you use one that is not in the plan’s network, an out-of-network pharmacy, you could be responsible for the full cost of the drugs.

How do I find network pharmacies?

When you join a plan, you will receive a provider directory or information about how to find it on the plan’s website. Once you establish an online account with your plan, you can also log in and find a pharmacy.

Is mail order service available?

Yes, you have the option to get 90-day supplies of prescribed medications through mail order, delivered to your home. Years ago, you could have gotten three months of medications for the price of two, but those days are gone. This service may be more cost-effective; however, in some plans, you can pay more for a drug than you would at a retail pharmacy. This is particularly true for higher-cost specialty medications. Always check your plan’s cost sharing or ask a pharmacist.

Do I have to get my drugs through the mail?

I heard from several recent retirees that their employer plans mandated the use of mail-order pharmacies for medications. There is no rule like that in Medicare; a plan cannot force you to use the mail-order service. You can mix and match retail pharmacies or get medications by mail, whatever works best.

Does it really matter which pharmacy I use if it’s in-network?

All pharmacies are not created equal. There are two categories of in-network pharmacies.

  • A standard retail pharmacy offers covered drugs at the plan’s negotiated price. Think of this as basic network pricing.
  • A preferred retail pharmacy is one that has a contract with the plan to offer covered drugs at lower out-of- pocket costs than what you would pay at other pharmacies. Not every drug plan includes preferred pharmacies.

Should I use only preferred pharmacies?

Generally, preferred pharmacies will be your most cost-effective option. However, during this year’s Open Enrollment Period, I found several examples in which drugs were more costly at a preferred pharmacy, sometimes double or triple the cost of that at a standard one.

The best advice is to compare costs at various pharmacies.

Do I have to use the pharmacy that is in the name of my drug plan?

No, you can choose any pharmacy that is in the plan’s directory. The one in the name has made special arrangements with the plan. In most cases, this can be the most cost-effective option but, once again, check your costs.

Do any retail pharmacies provide 90-day refills?

There are pharmacies that can provide 60- and 90-day refills. However, know that you may not be able to get more than a one-month supply of costly medications, such as Tier 5 specialty drugs.

Is it possible to get automatic refills of my prescriptions?

Yes, plans may offer a service that automatically delivers prescription refills. Talk with your plan about the details.

What pharmacy do I use if I need medications when I travel?

You can use any in-network pharmacy that has a national presence when you are away from home.

If, before Medicare, the coverage you had limited you to one or two pharmacies, you’ll be amazed at the number that are in some plans’ networks. All of those choices mean more work for you in trying to pick the most cost-effective and convenient option. Follow these tips.

  • Know how to access the plan’s directory to find pharmacies you can use.
  • Review the plan’s costs at different pharmacies. You can do this through your account. After logging in, click on View my plans (left side of screen) and then View plan details and drug costs (under your plan’s name).
  • Address any concerns with a plan representative or pharmacist.
  • Review the Explanation of Benefits you’ll receive from the drug plan for every month you get prescription medications.
  • And, a way-too-early recommendation, remember to pay attention during the 2023 Open Enrollment Period.