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Filling Prescriptions If Your New Drug Plan's ID Card Hasn't Arrived

Keep these tips in mind when you go to the pharmacy.

Q. I just switched to a different Part D plan, but my new card hasn’t arrived yet. How can I fill my prescriptions?

A. It can take time for your new coverage information to be uploaded onto Medicare’s pharmacy computer system—especially if you enrolled late in December, the busiest time of year for Medicare drug plans. But you can fill prescriptions in early January (or as soon as your coverage is supposed to begin) even without your card. Here are some tips to keep in mind when you go to the pharmacy:

  • Make sure you go to a pharmacy that’s in your new plan’s network or you’ll have to pay more at a pharmacy outside the network—maybe even full price. If you already visit one pharmacy regularly, ask if it accepts your new plan. Or visit the plan’s website to see which pharmacies in your area are in its network.
  • If you don’t yet have your new plan membership card, bring your Medicare ID card to the pharmacy along with, if possible, any of the following that shows you have a relationship with the plan:

-- a copy of your enrollment form.

-- a letter from the plan acknowledging your enrollment request. (Part D plans are required to respond within 10 days of receiving enrollment applications, as explained here.)

-- any other written materials the plan has sent you since you enrolled.

Ask the pharmacist to call the plan to confirm your coverage.

  • If you’re receiving, or have applied for, low-cost Extra Help benefits under Part D and your new plan’s card hasn’t arrived, bring your Medicare ID card to the pharmacy along with any of the following:

-- a letter from Medicare or Social Security saying you qualify for Extra Help.

-- a copy of your application for Extra Help, if you have one.

-- your Medicaid card, if you’re receiving health benefits from your state.

-- any document showing that you receive Supplemental Security Income (SSI) or have your Medicare premiums paid by your state.

Ask the pharmacist to call the plan to confirm your coverage.

  • If the pharmacist can’t immediately confirm coverage under your new plan, you can pay the full cost of your drugs, keep the receipts and later ask the plan for a refund. If you receive Extra Help or have applied for it, and can’t afford the prescriptions, ask the pharmacist to call Medicare’s pharmacy hot line for guidance on how to help you.
  • If the pharmacist confirms your coverage but says the plan won’t pay for one of your prescribed drugs—either because the plan doesn’t normally cover it or has placed a restriction on it—you may still be able to get it under Medicare’s “30 day rule.” This says that anyone who is newly enrolled in a Part D plan (even after switching from another Part D plan) and already taking the drug in question has the right to a temporary 30-day supply. Ask the pharmacist to fill the prescription under your plan’s “transition” or “first fill” policy.

Patricia Barry is a senior editor at the AARP Bulletin.

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