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What is a Medicare Pharmacy?

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  • Written By: wiseGEEK Writer
  • Edited By: O. Wallace
  • Last Modified Date: 29 April 2018
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The term Medicare pharmacy may have a few definitions that differ. In one definition this would be any pharmacy that meets standards to be a Medicare pharmacy and is thus able to work with Medicare patients to provide them with access to the drugs they need at contracted prices. Alternately, some people use this term to mean Medicare drug formulary, which is a listing of all medications covered by Medicare. These may vary depending on the type of prescription drug plan to which a person with Medicare subscribes.

The first example of Medicare pharmacy is a familiar idea to people who have had health insurance in the past. Essentially, people on Medicare or other types of insurance are told where to go to get prescriptions. They may be able to choose from several different pharmacies in their area. Choice is limited to the type of prescription drug plan (Medicare Part D) or sometimes Medicare Advantage Plan to which a person has subscribed. Often, there are many choices, but some plans have few choices or require people to obtain most drugs they take regularly through mail orders, which can be inconvenient.

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One reason people would want to use whatever Medicare pharmacy is recommended is because they may otherwise have to pay more for pharmacy services. Moreover, any contracting pharmacy has met whatever regulations exist to contract with the government or a government contracted private agency. Other advantages of a Medicare pharmacy are that it is likely to be able to quickly fill prescriptions for any drugs, suggest substitutions when drugs prescribed are not covered by Medicare, and easily figure out billing so that customers pay the appropriate amount. These features are all convenient to the customer and may make obtaining medicines far easier.

Medicare pharmacy and Medicare formulary are commonly confused terms. In any form of health insurance, a drug formulary is derived which determines what medications are covered, and at what rate they are covered. Formularies typically have tiers, where newer and often brand name drugs cost must more than older, generic medicines. The idea of a formulary’s use in a Medicare pharmacy is a little bit complicated because each Medicare Part D plan can have a slightly different one.

People can search for plans based on lowest prices of the drugs they currently must take, but this isn’t always a good predictor of future pharmaceutical needs or costs. It can simply be important to note that virtually all Part D plans have exclusions and may offer different pricing on exactly the same drugs. Examining a formulary and reviewing overall coverage can prove useful in determining which plan is most advantageous.

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