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What Happens to Refill Prescriptions When Moving to a New Part D Plan?

Q. I’m switching to a different Part D drug plan for the new year. Will my refill prescriptions be transferred to the new plan?

A. It depends on these circumstances:

If you use mail-order service: Any refills unused by Dec. 31 can be transferred to your new Part D plan only if your mail-order pharmacy serves both plans. Call its customer service number to find out if it does serve your new plan. If it does not, ask your doctor to write another prescription and send it to the new plan’s mail-order pharmacy.

If you use a retail pharmacy: You can use the same refill prescription in January only if the pharmacy is in the network of the new plan as well as the old one. Otherwise, get another prescription from your doctor and take it to a pharmacy that is in the new plan’s network.

Remember that under Medicare rules you must always fill your prescriptions at pharmacies within your plan’s network—that is, at the mail-order or retail pharmacies that accept your plan’s card. If you go out of network (except in emergencies and circumstances specified by your plan), you could pay much more for your drugs, maybe even full price. Also, such payments do not count toward your out-of-pocket spending limit that gets you out of the doughnut hole (the gap in coverage) if your drug costs are high enough to put you in it.

Bottom line: When switching plans, check out the new plan’s list of in-network pharmacies in your area. To find the list, look in your enrollment documents, visit the plan’s website or call its customer help line.

Patricia Barry is a senior editor at the AARP Bulletin.


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