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FAQs on Pharmacies and Part D



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Category: Pharmacies and Part D


Most Viewed FAQs in Category
What pharmacies do Medicare Part D plans like Humana or UnitedHealthcare use.
Almost all major pharmacies.  Most Medicare Part D plans offered by companies like Humana or UnitedHealthCare/AARP have 50,000 to 60,000 pharmacies in their plan network.  Because of the hu . . .

I received my card and my last name is mis-spelled. My pharmacy won't fill my prescription because my name is spelled wrong.
Unfortunately, on rare occasions your name could be misspelled on your membership card.    Your pharmacist may be able to contact your Medicare Part D prescription drug plan and get the . . .

What is a Preferred Pharmacy in Medicare Part D?
A  Preferred Pharmacy, according to the Centers for Medicare and Medicaid (CMS) is defined as: A network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what . . .

Can the co-pays for the shingles vaccine (Zostavax) vary by the pharmacy where purchased and administered?
Yes, the cost-sharing for any Medicare Part D prescription drug might vary depending on the chosen Medicare prescription drug plan and pharmacy. For example, if we are looking at stand-alone 2015 M . . .

What is a non-preferred or standard network pharmacy in Medicare Part D?
The Centers for Medicare and Medicaid (CMS) defines a non-preferred or standard network pharmacy as: "A pharmacy that's part of a Medicare drug plan's [pharmacy] network, but isn't a preferred pha . . .

How can the Pharmacy see if my Medicare Part D plan is active?
Your pharmacy can send a test claim through their point of sale system (POS) to check on the status of your membership, as long as you have either your membership card or the information from your mem . . .

The pharmacy couldn't fill my prescription. What should I do?
First, try to find out from your pharmacist why the prescription couldn't be filled. The pharmacist may be able to give you this information and may be able to give you or recommend another drug yo . . .

I went to the pharmacy and they charged full price for my medicaitons instead of the Humana $30 co-pay, why?
There are a few things that could have happened.  For instance: 1. Perhaps you enrolled in the standard plan and not the enhanced or complete.  This would account for your having to pay . . .

I just picked up my medications and it cost me more than I expected. My pharmacy told me that they are not one of my new Medicare plan's preferred pharmacies and so prescriptions will cost more. How can this be?
Each Medicare Part D plan has a national pharmacy network that includes 50,000 to 60,000+ pharmacies and both "preferred" and "standard" pharmacies are included in a Medicare prescription drug plan& . . .

Who determines the retail price of Medicare Part D drugs?
Many Medicare Part D prescription drug plans use a PBM or Pharmacy Benefit Manager to negotiate the plan's retail drug prices.  PBMs might also establish pharmacy networks, offer mail-order phar . . .

Newest FAQs in Category
Can my Medicare Part D plan change their pharmacy network during the plan year?
Yes. Medicare prescription drug plans (PDP and MAPD) have the right to add or drop participating pharmacies from the plan's pharmacy network throughout the plan year - or change a pharmacy’s s . . .

How do I get reimbursed for non-network pharmacy purchases?
Asking your Medicare Part D prescription drug plan for reimbursement for non-network pharmacy purchases is similar to asking for a refund of overpaid premiums and copayments The following is informat . . .

Can the co-pays for the shingles vaccine (Zostavax) vary by the pharmacy where purchased and administered?
Yes, the cost-sharing for any Medicare Part D prescription drug might vary depending on the chosen Medicare prescription drug plan and pharmacy. For example, if we are looking at stand-alone 2015 M . . .

Who determines the retail price of Medicare Part D drugs?
Many Medicare Part D prescription drug plans use a PBM or Pharmacy Benefit Manager to negotiate the plan's retail drug prices.  PBMs might also establish pharmacy networks, offer mail-order phar . . .

I changed Medicare Part D plans this year, but I still plan to get my medications at the same pharmacy as last year. Will my prescriptions transfer to the new drug plan?
Yes.  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 - this is assuming th . . .

I received my card and my last name is mis-spelled. My pharmacy won't fill my prescription because my name is spelled wrong.
Unfortunately, on rare occasions your name could be misspelled on your membership card.    Your pharmacist may be able to contact your Medicare Part D prescription drug plan and get the . . .

How can the Pharmacy see if my Medicare Part D plan is active?
Your pharmacy can send a test claim through their point of sale system (POS) to check on the status of your membership, as long as you have either your membership card or the information from your mem . . .

I just picked up my medications and it cost me more than I expected. My pharmacy told me that they are not one of my new Medicare plan's preferred pharmacies and so prescriptions will cost more. How can this be?
Each Medicare Part D plan has a national pharmacy network that includes 50,000 to 60,000+ pharmacies and both "preferred" and "standard" pharmacies are included in a Medicare prescription drug plan& . . .

If I just joined a new Medicare Part D prescription plan, do I need to change pharmacies in order to pay the lowest prices for my medications?
In some cases.  There are two reasons that you may need to change pharmacies when changing Medicare Part D prescription drug plans: (1) your pharmacy may no longer be included in your new Medic . . .

The pharmacy couldn't fill my prescription. What should I do?
First, try to find out from your pharmacist why the prescription couldn't be filled. The pharmacist may be able to give you this information and may be able to give you or recommend another drug yo . . .






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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.