The Med Diva

An insider's guide to Medicare Part D and more

New Government Rules Affect Medicare Part D Mail-Order Pharmacy Services

Medicare Part D

A few weeks ago I posted important news about a big change that affects Medicare beneficiaries who get their medications from a Medicare Part D mail-order pharmacy. Based on feedback I have received, many Medicare Part D plan members still do not understand how this rule affects them. That means a lot of people are probably wondering why they haven’t received their medications.

So let me try to help and explain this new rule again:

As of January 1, 2014, you must give your mail-order pharmacy permission to dispense and ship every prescription.

For example:
• If your doctor calls in a prescription, sends an e-prescription, or sends a prescription by fax to your mail-order pharmacy, you still need to give the pharmacy permission to process that order. This rule applies whether your doctor is ordering a NEW prescription or is RENEWING a prescription that has expired.

• If you normally get refills every three months, you will need to give the pharmacy permission every three months for every medication.

• If you were previously enrolled in an automatic refill service, you are no longer able to use this type of service.* Under this new rule, your prescription drugs can no longer be automatically refilled and shipped to your home.

NOTE: The pharmacy will not be able to ship your medication until you provide permission and confirm that you want to get the order.

When Do I Need to Give My Permission?

If you place your own order: If you order your own new prescriptions or refills by phone, mail, or pharmacy website, you DO NOT have to provide any additional permission. The fact that you ordered the medication yourself is considered “providing permission” under this new Medicare rule.

If your doctor places the order: If your doctor calls in a new prescription or faxes a prescription to the pharmacy, you will need to provide permission to confirm that you want this medication.

If you need refills: If you have a refill that is waiting to be shipped, you must give your consent and confirm that you want your prescription to be refilled.*

How Do I Give Permission?

Depending on your mail-order pharmacy, there are several ways to provide consent when your pharmacy receives an order from your doctor or has a refill waiting to be shipped:

Online: If your mail-order pharmacy has a website, you may be able to go online to provide consent for refills, new prescriptions, or renewed prescriptions.

Email: Your pharmacy may send you an email with a link to a website where you can provide permission.

Phone: Your pharmacy may provide a phone number to call or use an automated phone message that asks you to give your consent over the phone.

In any case, the pharmacy will need to get your consent before shipping every order, so make sure they have your most current phone number or email address. Until you give permission, your order will not be processed and your medication will not be shipped.

If you are currently using a Medicare Part D mail-order pharmacy, you should have received information by mail, phone, or email regarding this change in service. If you haven’t received any information about this new Medicare rule, you should contact your plan or your mail-order pharmacy to confirm that they have your correct contact information on file.

Why Did Medicare Establish This Rule?

Many mail-order or home delivery pharmacies provide a convenient refill service that automatically ships prescription drugs when the customer is about to run out of medication. Unfortunately, some Medicare Part D plans never checked to find out if their customers still wanted or needed their drugs. The automatic refill service was simply put on auto-pilot, so to speak, and would send the medication to the person’s home every three months or so.

Once the drug was sent in the mail, the customer was stuck with it — even if he or she was no longer taking the medication. This waste was costing Medicare a lot of money. So the Centers for Medicare & Medicaid Services (CMS) decided to take action and create this new rule.

*If you are in a Medicare Part D plan that is sponsored by your current or former employer, some rules about automatic refills may not apply to you. Contact your plan or mail-order pharmacy for additional information about refills.

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