Upon eligibility for Medicare, the first step is to enroll in Part A and Part B. Drug coverage is offered to all Medicare recipients but requires enrolling in either a Medicare Prescription Drug Plan (PDP), or a Medicare Advantage that includes prescription drug coverage. Plans are sold by private insurance companies and will differ in premiums, out-of-pocket expenses and formularies (list of covered drugs). Once you find a plan that meets your needs, enroll when you are first eligible for Medicare avoid a late enrollment penalty.
How home delivery works
Medicare drug plans are likely to offer a home delivery service to receive pharmaceutical products taken regularly, referred to as maintenance medication. Some prescription drug plans include an option for a voluntary auto-ship program. This means you may choose to obtain maintenance medication either through a retail pharmacist or through mail order, and the same copay would apply.
For Medicare recipients with chronic conditions, such as arthritis, high blood pressure or high cholesterol, mail order is worth exploring. It would save you trips to the drug store initially and possibly going forward if you can reorder remotely, either by phone, mail or online. Mail order would be arranged through your insurance company’s home delivery service. This is known as the PBM (Pharmacy Benefits Manager). After your doctor transmits the prescription electronically to the PBM, the products should be delivered securely packed with free standard shipping.
As a convenience to customers, some pharmacies offer an automatic refill service. This ensures that your medications are replenished before you completely run out. It is important to keep track of the delivery schedule in case the prescription is no longer needed. The Centers for Medicare & Medicaid Services (CMS) issued a memorandum in 2014 that “Part D sponsors employing auto-ship programs as part of their mail-order services would need to obtain beneficiary consent prior to each delivery not directly initiated by the beneficiary.”
Ordering a 60- or 90-day supply of medications taken regularly should be more cost effective than filling one prescription at a time, assuming you know it will be needed for that duration. The prescribing physician’s validation would be required. If you typically order a 30-day supply but plan to travel extensively, ask your Part D plan administrator if they cover extended-day supplies. Also, check with the network pharmacy if this is permitted since they may limit the quantity released at one time. Federal or state regulations may impose restrictions as well.