Does Medicare Cover 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.

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.

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.

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.

“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.