Changes to Automatic Refill Services Under Medicare Part D Mail-Order Pharmacies in 2014
If you are a Medicare beneficiary who gets your medications from a Medicare Part D mail-order pharmacy, I have some important information that may affect your services starting in January 2014.
Many mail-order or home delivery pharmacies provide an automatic refill service that will automatically ship your prescription drugs when you are about to run out of medication. For example, if you have a 90-day prescription for a certain medication, the mail-order pharmacy will automatically ship a refill when you have about two weeks of medication left. This service is very convenient, especially if you take several medications, and it has always been one of the main advantages of using a mail-order pharmacy.
Unfortunately, in recent years some prescription drug plans weren’t periodically checking 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 you received that drug in the mail, you were stuck with it whether you still needed it or not.
Since pharmacies are not allowed to restock prescription drugs that are sent by mail, some automatic delivery services were creating a lot of waste and unnecessary additional costs for people with Medicare and the Part D program in general. So the Centers for Medicare & Medicaid Services (CMS) decided to take action.
Starting January 1, 2014, mail-order pharmacies (and retail pharmacies with home delivery service) must get your approval before they will ship or deliver a new prescription or refill. That means that if you normally get refills every three months, you will need to provide your consent every three months for every medication. Even if your doctor calls in a new prescription, you will still need to provide your authorization. The pharmacy will not be able to ship your medication until you confirm you want to get the order.
Depending on your mail-order pharmacy, you may have to go to a website or reply to an email to provide authorization, or the pharmacy may call you on the phone to get your consent. Either way, the pharmacy will need to reach you before shipping every order, so make sure they have your most current phone number or email address. Until someone from the pharmacy reaches you and gets your consent, the pharmacy will not be able to process the order and ship your medication.
Keep in mind that if you place an order for medication yourself — whether by phone, mail, or online — you will not have to provide additional consent when the medication is ready to be shipped. Also note that this new policy won’t affect refill reminder programs at retail pharmacies when you go in person to pick up the medication. It also won’t apply to long-term care pharmacies that give out and deliver prescription drugs.
If you are currently using a Medicare Part D mail-order pharmacy, you should be receiving a notice by mail or email regarding this change in service. The notice should provide information that is specific to your plan and your pharmacy. If you don’t receive a notice by the first week of January, you should contact the mail-order pharmacy to confirm that your correct contact information is on file.