What You Need to Know About Mail Order Pharmacies

Are They the Right Choice for You?

Mail Order Pharmacies
Mail order pharmacies deliver medications to your door and usually cost less in copays. Lane Oatey/Blue Jean Images/Getty Images

You have a choice about where to fill your medications. With any number of local retail pharmacies around the corner, you can pick between larger chain stores or more intimate mom-and-pop pharmacies, as long as your Part D plan includes them in their network. The question is when is it better to choose a mail order pharmacy?

Choosing Between a Local Retail Pharmacy and a Mail Order Pharmacy 

Local pharmacies have the benefit of having a pharmacist on site to answer your questions and can be a great place to pick up any prescriptions you need right away.

This may be the case when your doctor prescribes a one-time only medication like an antibiotic or adds a new long-term medication to your regimen. It would not be prudent to wait days before starting a medication to control, for example, your blood pressure. You need quick and easy access to medications to keep you well.

Sometimes it can be hard to get to the pharmacy. Even if you are not home bound, the convenience of a mail order pharmacy is clear. Medications will arrive on your doorstep without your having to leave the comforts of home. The challenge is to have those medications ordered in a timely manner so they arrive when you need them and hope that nothing gets lost in the mail.

Many Part D plans will incentivize you to use mail order pharmacies by charging lower copayments than if you got your prescriptions from a local retail pharmacy. Keeping costs down is one reason to consider a mail order pharmacy.

How Mail Order Pharmacies Work

The first time you use a mail order pharmacy you will complete a paper application and mail it to the pharmacy for processing. Information required will include, at a minimum, your Part D plan identification number, allergies, address and billing information. A copy of your prescriptions will also need to be sent with your application.

Future prescriptions or refills may be processed by mail, online or by phone depending on what mail order pharmacy you use. With the government promoting the use of electronic health records, your doctor can directly send prescriptions to your mail order pharmacy through the computer. However, controlled substances may sometimes require print prescriptions, in which case you must send your prescription request by mail.

Mail order programs generally do not fill prescriptions on a monthly basis. They prefer to fill 60- or 90- day supplies. This means you may only need four to six refills per year for your maintenance medications.

Think About the Donut Hole

Copays for mail order prescriptions are usually less expensive than if you purchased three separate months of refills. While that may sound great at first, there is a caveat.

The amount you and your Part D plan spend on your medications counts towards the initial coverage limit. In 2016, this will be $3,310. After that, you enter the donut hole and will pay a larger percentage of costs for your drugs, 45 percent for brand name drugs and 58 percent for generic drugs.

Though you may save a small amount on your copay by filling a 90-day supply up front, your Part D plan is still left to spend their full share.

With three months of spending happening in just one month, you may reach the donut hole threshold sooner. This is especially true if you take multiple medications or take more expensive medications.

It may make sense to get some medications by mail order and others at your local pharmacy to delay entry into the donut hole. Generally speaking, mail order for generics makes sense since they are less expensive and less likely to push you into the donut hole. Depending on the number and cost of your brand name medications, you may need to consider whether mail order is right for you. Only you know your budget and whether or not you can afford to reach the donut hole early.

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