Does Medicare Cover Pharmacy Home Delivery?
Most Medicare Part D prescription drug plans and Medicare Advantage plans that offer drug coverage allow the option of home delivery. In-network pharmacies that have a home delivery service will provide it to you.
Does Medicare Pay for Pharmacy Home Delivery?
Original Medicare — Medicare Part A and Part B — does not cover most prescriptions. You have to buy a Medicare Advantage plan that offers drug coverage or a Medicare Part D prescription drug plan from a private insurer if you want Medicare prescription coverage.
Most of these private plans allow you to set up automatic refills for your prescriptions and to have your medications delivered to your home.
Medicare Advantage and Part D plans will typically pay for 90-day prescription supplies through mail order because they tend to be less expensive than 30-day supplies. These are available through both mail order and many local retail pharmacies covered by your plan.
Using a Mail Order Pharmacy with Medicare Advantage or Part D Plans
Medicare drug plans — both Medicare Advantage and Part D plans — are required to provide at least a minimum amount of coverage set by Medicare.
But these plans can vary on which pharmacies they use, the drugs they cover and how much they charge you for copayments or coinsurance.
Medicare Advantage plans and Medicare Part D prescription drug plans rely on their own networks of pharmacies. Going to one outside the network means you will likely have to pay more for — or even the full cost of — your prescriptions.
Review your plan or talk to its administrator to check on your prescription home delivery options.
- Preferred Pharmacies
- You can save money by using your Medicare Advantage or Medicare Part D plan’s preferred pharmacies. These are pharmacies that have contracted with your plan to charge lower copays or coinsurance that you have to pay out-of-pocket.
- Mail-order programs
- Some Medicare Advantage and Medicare Part D plans allow you to get up to a three-month supply of prescription drugs the plan covers. These are sent directly to your home and can save you money.
- Two- and three-month retail pharmacy programs
- Some local, retail pharmacies in your neighborhood may be in your network and may allow you to receive a two- or three-month supply of prescription medications. Check to see if your pharmacy is in your plan’s network and if it has this program.
Remember that these plans also have their own formularies — or lists of drugs they cover. You should make sure that drugs you take are included on a plan’s formulary before purchasing a Medicare Advantage or Medicare Part D plan. And you should check for changes in the plan’s formulary every year.
- Plans must give you at least 30 days’ notice before the change takes effect.
- At the time of a refill, plans must give you written notice of the change and cover at least a one-month supply of the drug under the plan’s rules before the change.
Prescription Home Delivery with Medicare During COVID-19 and Disasters
Medicare allows Medicare drug plans to relax their policies in certain cases of natural disaster or what it calls “a quarantine situation.”
The rule takes effect if people have difficulty getting to a retail pharmacy, are prohibited from going to a pharmacy or if the disaster or other situation makes mail-order or home delivery of prescriptions difficult or impossible for pharmacies to provide.
Emergencies that cause these problems typically include hurricanes or other major storms, wildfires, floods, earthquakes or other disasters that damage drug supply chains or local infrastructure.
The U.S. Centers for Medicare & Medicaid Services further expanded these rules in March 2020 to adjust to the COVID-19 pandemic.
- Relaxing restrictions on home or mail order delivery of prescriptions
- Removing prior authorization requirements
- Waiving prescription refill limits
“CMS encourages issuers to lift fill restrictions when appropriate, while also taking into consideration patient safety risks associated with early refills for certain drug classes, such as opioids, benzodiazepines, and stimulants,” the centers wrote in a memo to Medicare Part D and Medicare Advantage plans.
7 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, August). How Medicare Drug Plans Use Pharmacies, Formularies and Common Coverage Rules. Retrieved from https://www.medicare.gov/Pubs/pdf/11136-Pharmacies-Formularies-Coverage-Rules.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, March 24). FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets. Retrieved from https://www.cms.gov/files/document/faqs-rx-covid-19.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, March 10). CMS Issues Guidance to Help Medicare Advantage and Part D Plans Respond to COVID-19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-guidance-help-medicare-advantage-and-part-d-plans-respond-covid-19
- U.S. Centers for Medicare & Medicaid Services. (2020, March 10).Information Related to Coronavirus Disease 2019 – COVID-19. Retrieved from https://www.cms.gov/files/document/updated-guidance-ma-and-part-d-plan-sponsors-42120.pdf
- U.S. Centers for Medicare & Medicaid Services. (2019, September). Your Guide to Medicare Prescription Drug Coverage. Retrieved from https://www.medicare.gov/Pubs/pdf/11109-Your-Guide-to-Medicare-Prescrip-Drug-Cov.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Getting Prescriptions in Disaster or Emergency. Retrieved from https://www.medicare.gov/what-medicare-covers/getting-prescriptions-in-disaster-or-emergency
- Medical News Today. (n.d.). Does Medicare Deliver Prescriptions to a Person’s Home? Retrieved from https://www.medicalnewstoday.com/articles/medicare-pharmacy-home-delivery