Medicare Mail Order Prescriptions: How to Set Them Up
You can get Medicare prescriptions by mail, but only through a Medicare drug plan (Part D, or a Medicare Advantage plan that includes drug coverage). Original Medicare does not pay for most pharmacy drugs. Your plan decides whether it offers a mail-order pharmacy, which one it uses, and how much you pay. Plans can’t make you use mail order, so it is always your choice.
This guide explains how to start, what to check in your plan’s rules, and how mail order compares with your local pharmacy.
TL;DR
- Mail order is a feature of your Medicare drug plan. Original Medicare alone doesn’t cover most pharmacy drugs, so you need a drug plan to use it.
- Plans can’t require mail order. Many offer up to a 3-month supply delivered to your home.
- Only your plan’s network mail-order pharmacy counts. Check your plan’s pharmacy directory first.
- Order early. Plans commonly ask you to reorder 10 days to two weeks before you run out.
- Your costs can differ between mail order, preferred pharmacies and standard retail pharmacies, so compare before you switch.
Table of Contents
- Does Medicare cover prescriptions you get by mail?
- How mail order works under Part D
- How to set up Medicare mail order step by step
- Timing and supply limits to check
- Pharmacy networks and preferred pharmacies
- Mail order or your local pharmacy: which costs less?
- Can prescription medicine be mailed by USPS?
- Medical equipment by mail
- How Almond Insurance can help
- Before you enroll or switch plans
- FAQ
- Sources
Does Medicare cover prescriptions you get by mail?
Yes, if the drug is covered by your Part D plan and the mail-order pharmacy is in the plan’s network. Medicare.gov explains that Part B doesn’t cover most drugs you get at the pharmacy, so you need to join a Medicare drug plan or a health plan with drug coverage. Those plans are run by private companies that Medicare approves, and they must follow Medicare’s rules.
Part B does cover a limited number of outpatient drugs. These are usually drugs you wouldn’t typically give yourself, such as those given in a doctor’s office or hospital outpatient setting. Part D covers the drugs Part B doesn’t.
If you have Original Medicare, drug coverage is optional. You can add a separate drug plan, and most have a monthly premium on top of your Part B premium. If you’re in a Medicare Advantage plan, drug coverage is usually built in, and mail order works through that plan.
For a fuller look at premiums, formularies and costs, see our guide to Medicare Part D.
How mail order works under Part D
Medicare says some plans offer a mail-order program that sends up to a 3-month supply of covered drugs to your home. Some also offer an automatic refill service.
A few rules matter:
- It’s optional for you. Medicare’s drug coverage guide says plans can’t make you use a mail-order pharmacy. It also says plans should get your approval before mailing a new prescription or refill, unless you asked for it.
- It’s optional for plans. Under the CMS Part D manual, including a mail-order pharmacy in the network is up to the plan. Not every plan has one, and each plan names its own.
- Your plan picks the pharmacy. You can’t pick any online pharmacy and expect your plan to pay. The mail-order pharmacy needs a contract with your plan.
The approval rule is useful in practice. If a package shows up that you didn’t ask for, call your plan’s member services number on your ID card. Prescriptions you fill through other channels, such as a telehealth program that ships compounded medications, may not run through your Part D plan at all. If you use one, ask your plan how it treats those fills. You can read about how one provider-supervised delivery program works to see how the intake and shipping process differs from plan-based mail order.
How to set up Medicare mail order step by step
The exact steps vary by plan, but most offer several ways to start. Plans commonly give you a choice of these routes, as one national plan’s mail-service signup page and its pharmacy materials show:
- Find your plan’s mail-order pharmacy. Look in your plan’s pharmacy directory, member website or the number on your member ID card.
- Ask your doctor to e-prescribe. Your prescriber can send a prescription electronically to the plan’s mail-order pharmacy. Ask for a 90-day quantity when it’s appropriate for your medicine, so the pharmacy can fill a longer supply.
- Register online. Log in to your plan’s secure member website and choose mail order.
- Mail a form. Download the mail-order form from your plan, fill it out and send it with your written prescription.
- Call member services. Many plans will start the order and contact your doctor for you.
The pharmacy may need to confirm details with your doctor before it ships. Your first order can take longer than later refills, so don’t start with your last few pills in the bottle.
Get a bridge supply at your local pharmacy
If you’re switching a medicine you take every day, fill one more time at your local network pharmacy while the mail order is processed. That avoids a gap if the first order is delayed or needs a doctor’s call.
Timing and supply limits to check
Check these four things in your plan’s documents before you rely on mail order.
Delivery time. Plan materials commonly say mail orders arrive within about 10 days after the pharmacy gets the order. One national plan says most orders arrive no more than 10 days after they are received. Some plans quote a different range. For example, one regional plan’s directory says five to eight business days from the time the pharmacy receives the order (a 2019 document, so check your own plan’s current terms).
When to reorder. Plan guidance varies. One plan says to place an order at least two weeks before your prescription runs out. Another model plan document says to contact the pharmacy 10 days before you run out. A good habit is to reorder when you have about two weeks left.
How much you can order. Limits depend on the plan and the drug tier. One plan lets you order up to a three-month supply of Tier 1 through Tier 4 drugs, and up to a one-month supply of specialty Tier 5 drugs. Another model plan document allows orders of at least a 22-day supply and no more than a 90-day supply. A long-term supply is generally 90 days on a standalone drug plan, and one national plan says it is 100 days on a Medicare Advantage plan with drug coverage.
Shipping and refills. Some plans ship at no added cost and offer automatic refills. Automatic refills are convenient, but a dose change from your doctor can leave you with a stale order, so review them whenever your prescriptions change.
| What to check | Where to find it |
|---|---|
| Is a mail-order pharmacy in my network? | Plan pharmacy directory or member services |
| Maximum supply per order | Plan formulary and mail-order page |
| Cost for a 90-day supply by mail vs. retail | Evidence of Coverage, member website |
| Typical delivery time | Plan’s mail-order page |
| Refill reminders or auto-refill | Member account settings |
Pharmacy networks and preferred pharmacies
Your plan has contracts with a set of pharmacies called its network. Medicare explains that in-network pharmacies have agreed to offer a discounted price to members, and some plans only cover your drugs when you fill them at one of these pharmacies. A network pharmacy fills your prescriptions at a price your plan negotiated, and that price helps set what you pay.
Some plans also name preferred pharmacies. Medicare says preferred in-network pharmacies may save you money because they agreed to charge less than other pharmacies in the plan’s network. In some plans, the mail-order pharmacy is a preferred pharmacy. In others, it’s a local chain or independent pharmacy. The only way to know is to look at your own plan.
How to check your plan’s network
Most plans let you do any of these:
- Search the pharmacy list on the plan’s website. One national plan says it updates its online list every two weeks.
- Ask for a printed directory by mail.
- Call member services and ask for a list of nearby pharmacies.
Also check this each fall. Pharmacy networks and drug lists can change from one plan year to the next, so a pharmacy that was preferred last year may not be this year. Our guide to Medicare enrollment periods explains when you can change plans.
Mail order or your local pharmacy: which costs less?
There’s no one answer. It depends on your plan, your drug’s tier and the pharmacy’s status.
Medicare tells you that you can use your drug coverage at your local retail pharmacy, and that you can ask your plan about a 2- or 3-month supply however you get your drugs. Under CMS rules, if your plan includes a mail-order pharmacy, it must let you get an extended supply, such as 90 days, at a network retail pharmacy instead if you choose. You may then pay a higher cost share, limited to the difference between the retail and mail-order contract rates.
Here is a simple way to compare, using your plan’s own numbers:
- Write down each medicine, its dose and how often you take it.
- Look up the cost of a 30-day fill at a local network pharmacy.
- Look up the cost of a 90-day fill by mail and at a preferred retail pharmacy, if your plan has one.
- Divide by months to get a monthly cost for each option.
- Add anything that matters to you that isn’t a price, such as delivery to a caregiver’s address, in-person counseling or a pharmacist who knows you.
Mail order often suits steady, long-term medicines like blood pressure or cholesterol drugs. Local pickup can suit new medicines, antibiotics and anything you need today. Many people use both.
Costs change with the plan year. Our Medicare costs overview lists current premiums, deductibles and caps.
Can prescription medicine be mailed by USPS?
Yes, through a licensed pharmacy, which is how plan mail order works. The U.S. Postal Service’s Publication 52 sets the rules for mailing drugs and controlled substances, and these rules cover how drugs are packaged and who may send them. Mail-order pharmacies follow them for you. Your plan’s pharmacy may ship by USPS, UPS or another carrier.
For you, the practical points are:
- Have the pharmacy ship to an address where someone can receive the package. Heat can matter for some medicines, so don’t leave boxes in a mailbox or on a porch.
- If a medicine needs refrigeration or a signature, the pharmacy will tell you how it ships. Ask when you set up the order.
- If a package is late, damaged or missing, call the mail-order pharmacy first, then your plan’s member services.
- Don’t mail your own leftover prescription drugs to a friend or relative. The Postal Service’s rules restrict who may mail prescription drugs, and sharing medicine is unsafe.
For questions about a specific medicine, such as a controlled substance or a temperature-sensitive drug, ask your plan’s pharmacy or your pharmacist.
Medical equipment by mail
People who search for mail-order prescriptions often ask about medical equipment too. It works differently, because equipment falls under Part B rather than your drug plan.
Medicare Part B covers medically necessary durable medical equipment (DME) that a doctor or other health care provider prescribes for use in your home. Federal rules require a written order that includes your name or Medicare number, a description of the item, the order date and the practitioner’s name and signature, per 42 CFR 410.38. Generally you pay 20% of the Medicare-approved amount after the Part B deductible. Most DME is rented, and ownership of some items passes to you after 13 months.
Medicare’s guide to DME coverage says a nurse practitioner, physician assistant or clinical nurse specialist can also prescribe it. Many suppliers deliver to your door, but they must be enrolled in Medicare for Part B to pay. Ask the supplier whether it accepts Medicare assignment before you order. If you have a Medicare Advantage plan, your plan may have its own supplier network, so check before ordering.
How Almond Insurance can help
Mail-order rules look simple on paper. In practice they depend on which plan you have, which drugs you take and which pharmacies are in your network. We’re a local Medicare agency in Rockford, Illinois, and we help people across Northern Illinois and Southern Wisconsin compare drug coverage in plain language.
Our Part D prescription review looks at your medicines, your pharmacies and whether your current plan’s network, including mail order, fits how you fill prescriptions. You don’t pay us directly for the advice. If you’re new to Medicare, our enrollment support can walk you through each step.
If you’d like to talk through your options, start at our Medicare enrollment page or look at our Part D plan guidance.
Before you enroll or switch plans
If mail order matters to you, treat it as part of choosing a plan, not an afterthought.
- Make a list of your drugs and pharmacies before you compare plans.
- Check that each drug is on the formulary and note its tier.
- Confirm the mail-order pharmacy and preferred pharmacy status in the plan’s directory.
- Mind the deadlines. Missing your enrollment window can cost you later. Our guide to the late enrollment penalty explains how it works, and the Medicare enrollment checklist covers documents and steps.
FAQ
Does Medicare make you use mail order?
No. Medicare’s drug coverage guide says plans can’t make you use a mail-order pharmacy. You can keep filling prescriptions at a network retail pharmacy. Some plans cost less for a long-term supply by mail, so compare before you decide.
Does regular Medicare pay for prescriptions?
Original Medicare (Parts A and B) doesn’t cover most drugs you get at the pharmacy. Part B covers a limited set of outpatient drugs, usually those given in a doctor’s office or hospital outpatient setting. For most prescriptions, you need a Part D plan or a Medicare Advantage plan with drug coverage.
What is a preferred pharmacy in a Medicare plan?
It is an in-network pharmacy that has agreed to charge less than other pharmacies in the plan’s network. Using one may lower your out-of-pocket drug costs. Your plan’s pharmacy directory shows which pharmacies are preferred, and the list can change each plan year.
How do I know if a mail-order pharmacy is in my network?
Search your plan’s online pharmacy directory, request a printed copy, or call the member services number on your ID card. If the pharmacy isn’t in your network, your plan may not cover the fill, or may cover it at a higher cost.
Sources
- Your Guide to Medicare Drug Coverage (Medicare.gov)
- How do drug plans work? (Medicare.gov)
- Your coverage options (Medicare.gov)
- What pharmacies can I use? (Medicare.gov)
- Using your drug coverage (Medicare.gov)
- Qualified Prescription Drug Coverage, CMS Part D Manual Chapter 5
- Information about our pharmacy network (Aetna Medicare)
- RNC Pharmacy Directory (HealthPartners)
- Publication 52, Controlled Substances and Drugs (USPS)
- 42 CFR 410.38, Durable medical equipment (eCFR)
- Medicare Coverage of DME and Other Devices (Medicare.gov)