Medicare and Mail Order Prescriptions


Mail-order prescriptions and Medicare go hand in hand; those using this convenient option save time. It’s a hassle to visit the doctor, don’t make the pharmacy another stop. If you have Medicare Part D and a few scripts, mail order pharmacy could save you money. For those who have a disability, getting around can be an issue. Many health conditions leave seniors stuck in their homes.

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Companies like Walgreens, CVS, and Amazon offer the delivery of prescriptions by mail. Most health insurance companies provide mail-order services. About 3 in 5 American adults take at least one medication. Seniors across the country opt for mail-order prescriptions. Those using Medicare and mail order prescriptions find the 90-day supply is cheaper than buying on a month-to-month basis.

Does Medicare Have a Mail Order Pharmacy?

Part A and B benefits don’t include drug coverage, but if you have Medicare, you’re eligible for Part D. You may need to do one of two things. The first option is to enroll in a Drug Plan. The other option is to buy a Medicare Advantage Plan.

Private insurance companies offer both Part C and D plans. You can buy these plans for medications. Medicare companies set guidelines for mail-order pharmacy benefits.

Can I Get My Prescriptions Delivered to my House?

With the trend in rising prescription costs, it’s no wonder people look for solutions to save money. Pharmacy companies like OptumRx offer home delivery for over 1.3 billion scripts each year.

That’s just one company – the healthcare market is full of similar businesses. Think about signing up for home delivery for drugs before making any decisions.

Understanding your Part D benefits is most important, contact your plan. An agent can explain the price difference of using a pharmacy vs. a home delivery option. Compare the pros and cons of if a home delivery service is best for you. Your condition, prescription, and situation may determine how you get your medication.

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Pros and Cons of Mail Order Pharmacy

As with everything, there are pros and cons of using a mail-order pharmacy. The first and most apparent benefit is ease. Getting a 90-day supply right at your front door is better than the 30-day supply you obtain after the doctor.

Those with current prescriptions may order refills by mail, phone, or online. The idea isn’t new; Veterans Affairs is one of the originators of the mail-order pharmacy business. The VA operates local pharmacies all over the country.

Does Medicare Part D Cover Mail Order Pharmacy?

Medicare does have a mail-order pharmacy option; however, Part D may have some policy limitations. Prior authorization may be necessary before your plan covers. Before filling prescriptions, you or your doctor may need to contact the plan.

If you need prior authorization, your doctor must prove the drug is necessary before the policy covers it. Other plans have quantity limits, which restrict how much medication you can get at one time.

Step therapy is another standard plan limitation. Step therapy requires that you try one or more generic drug before the plan covers brand-name prescriptions. Review your Part C or Part D plan rules before enrolling in mail-order pharmacy services. Some situations require immediate treatment; go to your pharmacy for antibiotics or antivirals.

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Top Medicare Mail Order Pharmacies

Whether trying to save money or trying to avoid a pharmacy trip, mail-order pharmacies may be a solution. Mail-order pharmacies are an excellent option for some; for others, the savings aren’t a guarantee. Most private insurance companies have at least one drug plan option.

Medications can become costly over time. Low deductibles and plan premiums could be higher than in the past. Other plans have quantity limits, which restrict how much medication you can get at one time. Step therapy is another standard plan limitation. Step therapy requires that you try one or more generic drug before the plan covers brand-name prescriptions.

Private insurance companies Humana, Aetna, Silver Script, and Mutual of Omaha are the top mail-order pharmacy companies. Those that don’t buy a drug plan when first eligible may incur a penalty. Anyone with credible Part D coverage won’t pay a late enrollment fee.

Can You Opt-Out of a Mail-Order Pharmacy?

In some states, you can opt out of a mail-order pharmacy option. New Hampshire offers a mail-order opt-out program to residents. The Opt-Out program helps people when mail-order causes more hardship.

In some cases, you may only get a 31-day supply – using a local pharmacy. However, recipients must pay the plan’s retail co-payment.

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If you choose to opt-out, the option of mail-order is available. When choosing to opt-out of the mail-order pharmacy option, requests take effect. The situation should be seamless, with minimal time or transfer.

Extra Help Program for Prescription Drug Costs

Qualifying for the Extra Help Program is possible after meeting the income and resource requirements. As with everything, there are pros and cons of using a mail-order pharmacy. The first and most apparent benefit is ease. Getting a 90-day supply right at your front door is better than the 30-day supply you obtain after the doctor.

If you have questions or concerns, an agent may be able to help. Give us a call at the number above or fill out our online rate form and get the process started today.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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