When it comes to pharmacies, people are very particular. There are some people that don't like the thought of leaving their local pharmacy just because they have enrolled into a new Medicare part D prescription drug plan. As they think of different options, most would like to stay with the pharmacy they know and have used for years rather than reestablishing those relationships.
What are in network pharmacies?
An in network pharmacy is a pharmacy the insurance provider has contracted with to provide services for their members. These pharmacies are willing to accept the insurance these members have and dispense the medications required for the set copay and negotiated prices. This is something that is very important for those that are concerned with the costs of their medications.
Why should I use these pharmacies?
Many people don't understand the benefit in network pharmacies offer. When they use the preferred pharmacies, they are able to get their medications at the prices their insurance has listed. When people enroll into a prescription drug plan, they are told copayment amounts, coinsurance amounts and negotiated prices based upon the contracts they have negotiated with the drug manufacturers and the in network pharmacies. Those are normally the prices that people are interested in paying when they use their Medicare prescription drug plans.
What happens when I use a non-network pharmacy?
Those that choose not to use an in network pharmacy sometimes find they will have to pay more money out of pocket when they go to pick up their medications. A non-network pharmacy isn't contracted with the insurance providers to accept the insurance and give the negotiated prices and copays. Without that contract, Medicare beneficiaries are normally requested to pay retail prices for their medications and forced to ask their insurer to provide a reimbursement of their out of pocket expenses.
What happens to my Part D benefits?
Those that choose to use a non-network pharmacy have the option to pay those prices and not have them applied to their Medicare part D insurance. There are also some that choose to have their out of pocket expenses applied to their Medicare part D plans. Those that choose to have the amounts they paid applied to their benefits and receive a reimbursement can do so by contacting their part D insurance provider and requesting a reimbursement form.
A reimbursement form will request specific information and proof of the transaction. Beneficiaries will have to complete the information on the form as well as attach the receipt or a copy of the receipt of the transaction. Once that information is mailed into the insurance provider, it will be reviewed and a reimbursement check will paid if the purchase fits the criteria. The reimbursement process can take up to 8 weeks to complete.
What if I am traveling?
When an insurance provider contracts with a pharmacy to be an in network pharmacy, they normally include all locations in the country. If a beneficiary is traveling and needs to fill or pick up a medication, they are usually able to use any pharmacy location as long as that particular pharmacy is in network. Those that travel find it easier to call their part D insurance provider to get a list of pharmacies in the area they are traveling to that are within the network.
Is mail order an in network pharmacy option?
There are millions of people that want to receive their medications via mail order and don't know if it's something that is allowed on their prescription drug plan. Because Medicare drug plans are different, there are different benefits that are provided. Those that offer mail order often have a contracted mail order pharmacy to handle the needs of those that want to use those services. The insurance providers that offer these services have a list of mail order pharmacies that are in network as well.
When it comes to regularly filling medications, it is important that the pharmacy is local and convenient. There are many people that don't have the means to travel long distances to get their medications filled and prescription drug insurers understand that. They try to have as many pharmacies within their network as possible to help as many of their beneficiaries as possible. Many people find they don't have to change their pharmacy because of their new part D insurance; they are thrilled to find they are already using an in network pharmacy.