It is a very nerve wrecking time for those that are new to Medicare Part D prescription drug plans to get their prescriptions filled. Many of these new members are nervous because they aren't sure they made the right decision with their plan provider and they don't know if things will work as smoothly as it should for them. As these members worry, they wonder if they can continue to use their same pharmacy and if not, where will they get their prescriptions filled.
New Enrollee, New Pharmacy?
For many different reasons, people enroll into a different Medicare Part D prescription drug plan each year. They could be unhappy with their previous prescription drug plan, new enrollees or many other things. When they enroll into their new prescription drug plan, many of them have the same question; where can they fill their prescriptions when the new prescription drug plan comes into effect?
Most Medicare Part D prescription drug plan providers offer their members many different options for getting their medications filled. These offerings include a new local pharmacy, the same pharmacy they have been going to or even a mail order option. When people find these different options are available, they often have many different questions. For those that want to stay with their current pharmacy, they need to speak with their prescription plan provider to ensure their current pharmacy is part of their network of pharmacies.
What is an In-Network Pharmacy?
A network pharmacy is a pharmacy the prescription drug plan provider has worked and contracted with to provide services for their members. These pharmacies are willing to accept the insurance that is carried by the member and provide them with the medications that are needed. They do this for negotiated prices and fees because it is in the contract they agreed to with the insurance provider.
It is very important for those that have a Medicare Part D prescription drug plan to use a pharmacy that is within the network. The pharmacies that are in the network are able to give the medications to members at a predetermined price. For those that are on a budget, this is very important. These are the prices that are quoted when a member enrolls into a prescription drug plan.
What if I Use a Non-network Pharmacy?
Whenever a member uses a non-network pharmacy, there are no guarantees when it comes to pricing. A pharmacy that isn't in the network of pharmacies that agreed to the insurance's pricing isn't obligated to give members the medication at the contracted prices. These pharmacies often can't accept the member's insurance card because they don't have a contract with those insurance companies.
When there is no contract, the members that choose to use these pharmacies often find themselves paying the retail prices for medications. They would then have to contact their insurance company, submit a claim form and receipts so they can be reimbursed for the money they have spent out of pocket. This is a process that can take anywhere from 4-8 weeks to be processed and a reimbursement check to be approved and mailed. For members that are living on a fixed income, using a non-network pharmacy isn't worth the additional money and time spent.
What if I'm On Vacation?
There are many different members that choose to have their medications filled while they are on vacation. Many worry if they will be able to use their Medicare prescription drug insurance to get their normal copays. Many of these insurance programs offer their members nationwide coverage and allow their members to fill different prescriptions at a pharmacy anywhere in the country. If those pharmacies are in network, they are able to get their medications at the negotiated prices and copays.
Is a Traditional Pharmacy My Only Option?
Not all Medicare beneficiaries are able to get to a traditional retail pharmacy to get their medications each month. For those members, many insurance providers have found they are able to offer their members the option of having their medications delivered to them via mail order pharmacy. This is something that works very well for those that can't get to a pharmacy or just like the convenience of having their medicines delivered.
A mail order option is something that will allow members to have their medications mailed to them every three months. This can be a time and money saving benefit for members. There are some mail order companies that offer some medications at a lower price because it is ordered in 90 day intervals. When this happens, members save money on the cost of their prescriptions.
Members are able to call their mail order pharmacies with questions just as they would a traditional retail pharmacy. They are able to have their prescriptions mailed to the pharmacy or the doctor can send it directly to them. A lot of members find they enjoy the mail order option because they are able to get additional help in managing their prescriptions.
Many people think that just because they are using the mail order option they won't be able to use a retail pharmacy. That isn't true. Medicare prescription drug plans allow for either a retail or mail order option is used or both. There will be times that a member needs an emergency prescription filled. With their ability to use either option, members won't be forced to go without their medications.
As people make the change from their current Medicare Part D prescription plan to a new one, they need to understand what pharmacies are in their network. They may also what to inquire about the benefits of using a mail order pharmacy. When people take the time to ensure their favorite pharmacy is within their new plan's network, they save themselves a lot of money and time. Even if there is a time a non-network pharmacy has to be used, prescription plans are able to reimburse their members the money they paid up to a certain amount if they are notified.
Members take medications for a reason and Medicare Part D prescription drug plans don't intend on standing in the way of their members taking them. As these insurance providers thing about their members' needs, they think of pharmacies they can keep and place in their network to ensure there is one in every community. Whenever there is a question of a pharmacy or a pharmacy issue, it is important that members call their prescription insurance provider.