It’s My Medicare Insurance. Why Can’t I Use it in Canada?

When people pay for things, they want to use it in the way they see fit. This is something that people have done for a large part of their adult life. This holds true when it comes to insurance, especially Medicare part D prescription insurance. When a beneficiary goes to their doctor and they are prescribed a medication, they don’t often understand why they can’t get the medications they are prescribed without restrictions.

What do you mean?

When a member of a Medicare prescription drug plan has a medication, they normally go to the pharmacy and expect to have their medicines given to them without a problem. There are times there are problems in having those medications filled according to the doctor’s instructions. When this information is told to the beneficiary, they often are frustrated and don’t understand what could stop the prescription from being filled.

When it comes to Medicare prescription drug plans, there are certain rules and restrictions that have to be followed. Not all medications will be covered under a drug plan’s formulary. Not all medications can be dispensed in the quantity that is prescribed by the doctor. Most of these rules have been put in place because of the medication itself. There are some medications that aren’t approved to be taken in certain quantities because of the effects it has on the person taking them. There are other medications that Medicare and the Social Security Administration feel it shouldn’t be allowed on the formulary.

The rules that are put in place on a Medicare part D prescription drug plan medications aren’t put in place by the insurance companies. These rules are made by many different people and are in place for all insurance agencies that offer Medicare prescription drug plans. Some of the bodies that make the rules are:

·         Centers for Medicare and Medicaid Services

·         Social Security Administration

·         Board of Pharmacists

·         PBM (pharmacy benefit managers)

All these agencies work together to determine the cost of these medications, the usage of these medications and many other things. When these rules and determinations are made, insurance companies have to comply.

Can I get my medicines from Canada?

There are some people that feel their prescription drug plans are too restrictive. Rather than get their medications through their insurance plans, they feel they can get their medications from Canada. There are others that feel they should be able to use their Medicare prescription drug plans in a different country.

Everyone has a right to get their medications from the place of their choosing. Because of the contracts that Medicare has in place for their Medicare prescription drug plans, medications that are ordered from a different country to be shipped into the United States of America won’t be covered under these insurance plans. These orders can be placed and shipped into the country but the cost will have to be paid for at the expense of those that order them.

When it comes to medications, many people don’t like to venture away from their doctor’s orders and recommendations. They don’t like the thought of not being able to take their medications as they are prescribed. When there is a medical need for the rules to be overridden, they can be. When there is no benefit to the patient, those rules have to be followed. As people talk to their Medicare prescription drug plan providers, they often find there are alternatives to be used and there may be a way to get the medications as their doctors ordered them.

Rules for Medicare prescription drug plans aren’t put into place to annoy those that need them. They aren’t put in place just to get more money from the beneficiaries. The rulings for medications are put in place to help those that are most vulnerable get the best care possible and helps to decrease their chances of taking too much of a particular medication or even one that won’t benefit them at all. The groups of professionals that work to make the rules and review the medications allowed by the prescription drug plans have their customers’ best interests in mind and only want to ensure the best medications are available for use and can be made affordable to those that need it.

Nov. 16 12'

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