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If I change Medicare Part D plans, will my prescriptions transfer to the new drug plan?

Category: Changing Medicare Part D Plans
Updated: Oct, 29 2023


Yes.  In general, when you switch to a different Medicare Part D prescription drug plan (PDP or MAPD), your existing prescriptions will move to your new Medicare drug plan --- with a few exceptions noted below.

In many cases, if you change drug plans and stay with your same pharmacy, your pharmacy should automatically transfer your prescriptions to your newly chosen prescription drug plan - assuming that your pharmacy is also a part of your new Medicare Part D prescription drug plan’s pharmacy network.

Reminder:  Standard v. Preferred Network Pharmacy Pricing
Although Medicare Part D plans include 50,000 to 65,000 pharmacies in their network, most Medicare drug plans use both preferred and standard network pharmacies with different cost-sharing (copay/coinsurance) - usually with better drug prices at a preferred network pharmacy.  If your existing pharmacy is only one of your new Medicare plan's standard network pharmacies - and not a preferred network pharmacy - you may pay more for your medications.

However, here are a few possible exceptions to the general rule:
  • Changing to another pharmacy.  If you decide to change pharmacies with your new Medicare Part D plan to a more affordable preferred network pharmacy (for example, from CVS to Walgreens), you may need to provide your written prescriptions to the new pharmacy (or you may find that your prescriptions are transferred between competing pharmacies as a courtesy).

  • Changing to your new plan's mail order pharmacy.  In the same way, if you move from your current Medicare plan’s mail order to another mail order pharmacy associated with your new Medicare drug plan, you probably will need to provide new prescriptions to the new Medicare plan's mail order pharmacy (one mail order pharmacy may not communicate with another mail order pharmacy).

  • Your prescription is about to expire.  If your prescriptions are soon-to-be outdated or only written for a limited time, you may need to provide the pharmacy with new prescriptions -- with or without changing to a new Medicare plan.

  • Your prescription is for a limited quantity and you want an increased quantity.  If you decide to change to 90-day quantities, and your prescriptions are written only for 30-day quantities, you will need to ask your doctor for new 90-day prescriptions that you can submit to your new pharmacy.

  • Your prescription is for a "controlled" or often-overused medication.  If your prescriptions are for controlled substances or medications that are often over-used (such as opiates or other pain management medication), your new Medicare Part D plan may require new prescriptions to confirm that your prescriber still authorizes the drugs – so you will need to provide the pharmacy with new prescriptions.



Important:  A new plan year may mean new Usage Management Restrictions for your existing prescriptions.

Please keep in mind that next year's Medicare Part D prescription drug plan may now subject some (or all) of your medications to Usage Management Restrictions such as Prior Authorization (PA) or have Quantity Limits (QL) or require the use of Step-Therapy.

This means that your prescriptions have not changed and you still use the same pharmacy as last year, but now your Medicare drug plan now requires that you follow some new rules as applied to your prescriptions.  So you may have a limitation on the quantity of drugs the plan will cover for a period of time (such as 30 pills for 30 days) or your drug plan may require that you try a lower-costing generic alternative before agreeing to pay for your more-expensive brand name drug or your existing prescription will not be filled until you receive prior authorization from your drug plan.

You will need to then work with your Medicare plan and adhere to these new restrictions and you will need to work with your prescribing doctor to meet these requirements - or you have the right to ask your new Medicare drug plan for a formulary exception (a type of coverage determination) whereby the drug usage restrictions will be waived.

Formulary exception requests are not automatically granted and, if your request is denied, you have the right to file an appeal.





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