Yes. Medicare Part D prescription drug coverage is voluntary and, if
you find a cheaper place to purchase medications, then you are permitted buy your medications without using your Medicare Part D prescription drug plan.
However, there are a few things to consider when
purchasing your medications outside of your Medicare Part D plan that include:
You cannot combine discounts with coverage. A drug discount
program will usually not
work together with a Medicare Part D plan, so you cannot use a drug discount program along with your Medicare Part D coverage for added savings.
Drug discount cards do not always have the lowest price. As always, please calculate your savings
before using a drug discount program. You
may be paying more for your medications with a drug discount card than
with your Medicare Part D plan coverage. Some drug discount plans mention an
average savings of 50%. However,
the standard Medicare Part D plan design offers medications at 25% of the
retail price (a 75% savings).
Also if you have high
monthly retail drugs costs (for example, you buy drugs with an average monthly retail value of over $319 in 2019) you will reach your Medicare plan's
Coverage Gap and may be able to take advantage of the Donut Hole discounts where you will receive a 75%
discount on brand name drugs and a 63% discount on generic medications. (The Donut Hole discount will continue to increase until 2020 when all Donut Hole drug purchases will receive a 75% discount - meaning you only pay 25% of retail).
You can still submit receipts to your Medicare plan for drug purchases. You can submit the receipts for your formulary drug purchases (when not using your Medicare Part D plan) so that your Medicare plan
can track your overall drug spending and the amount of the drug purchase is added to your total out-of-pocket expenses (TrOOP). (You can only get credit for formulary
drug purchases made at network pharmacies and during the Initial
Deductible or Coverage Gap when you are 100% responsible for your drug
costs. ) You can contact your Member Services department about the procedure for submitting receipts). You can read more in our FAQ
on the Lower
Cash Price policy.
Drug discount programs are not a substitute for Medicare Part D drug coverage. If you are using a drug discount card, and decide to stop paying your Medicare Part D premiums in an effort to leave your
Medicare Part D plan, and do not have any other form of creditable
prescription drug coverage (VA, TRICARE, Employer coverage), you will be
subject to the permanent late-enrollment
premium penalty should you ever decide to re-enroll in a Medicare
prescription drug plan (and your unpaid premiums may be reported to a collection agency or you may be required to pay unpaid-premiums should you ever try to rejoin the same Medicare drug plan.)
Drug discount cards vs. the Donut Hole discount. If your 2019 average monthly retail drug costs are more than $319 but less than $680, you will enter the 2019 Coverage Gap, but may not have high enough out-of-pocket
drug spending exit the Coverage Gap and enter your Medicare Part D plan’s
Catastrophic Coverage phase (where you can receive a 95% discount on the
retail cost of your medications).
In this case, you can consider using a drug discount program for purchases made in the Donut Hole, if they are significantly less expensive than your cost using the Donut Hole discount (providing a discount of more than 75% of retail for brand drugs or a 63% retail discount for generics).
Ask about the pharmacy's everyday retail drug pricing. As an alternative to a
discount program, you can seek out retail pharmacies with everyday or “usual
and customary” low retail drug prices. Purchases from retailers with everyday low drug prices are not
considered a one-time discount or a discount program, so your Medicare
Part D coverage can be used together with the pharmacy's every-day low drug price. You
here to learn more about network pharmacies with lower, everyday retail