Using Your Medicare Drug Coverage at the Pharmacy

Adapted from Your Guide to Medicare Prescription Drug Coverage, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Using your Medicare drug coverage

Each company that offers Medicare drug coverage has a list of pharmacies you can use, called a network. If you want to continue filling prescriptions at the same pharmacy you use now, check to find out if that pharmacy is in-network. Contact your plan, your pharmacy, or 1-800-MEDICARE (1-800-633-4227) to find out if your pharmacy is in-network. TTY users can call 1-877-486-2048. Some Medicare drug plans or health plans with drug coverage offer a discount or only cover your drugs when you get them filled at a pharmacy in their network.

Along with local retail pharmacies, your plan’s network might include preferred pharmacies or a mail-order program.

Whichever way you choose to get your drugs, you can contact your plan to find out if you can get a two- or three-month supply for drugs you take regularly. This may be a cost-effective and convenient way to get your drugs.

Within 2 weeks after your drug plan gets your completed application, you’ll get a letter letting you know it got your information. Within 5 weeks, you should get a welcome package with your plan ID card.

To fill your prescription, bring:

• A photo ID (like a state driver’s license or passport).
• Your card for Medicare drug coverage.

You should also bring your red, white, and blue Medicare card, as proof that you get Medicare. If you have both Medicare and Medicaid, or qualify for Extra Help, you should also bring proof that you have Medicaid or proof that you qualify for Extra Help. This will help make sure you don’t pay more than you should for your prescription drugs

Visit Medicare.gov/basics/forms-publications-mailings/mailings/help to learn more about letters you get about Extra Help, or go to page 34 for information about what you can use to prove you get Extra Help and/or Medicaid.

How do I fill a prescription without my new plan card?

If you go to the pharmacy before you get your new drug plan card, you can prove you have coverage by showing:

• The acknowledgement, confirmation, or welcome letter you got from the plan.
• An enrollment confirmation number you got from the plan, and the plan name and phone number.
• A copy of your official Medicare card.

Note: If you haven’t gotten a plan membership card or any plan enrollment materials, tell your pharmacist the name of your plan. This can help them confirm your plan enrollment and get the information they need to bill your plan.

If you don’t have any of the items above, your pharmacist may still be able to get your drug plan information. You’ll need to give them your Medicare Number or the last 4 digits of your Social Security Number.

If your pharmacist can’t get your drug plan information, your doctor may be able to give you a sample of your prescription drug until your coverage is confirmed, or you may have to pay out of pocket for the entire cost of your drug.

If you pay out of pocket for your drugs, save your receipts, and contact your plan. You may be able to get back some of what you spend, or have the amount credited toward your out-of-pocket costs.

Can I use a mail-order pharmacy?

Plans can’t make you use a mail-order pharmacy, but you may have this option if you want to use it.

Plans should get your approval to deliver a prescription drug (new or refill) in the mail (unless you ask for the refill or new prescription). Some plans may ask for your approval every year, and other plans may ask before every delivery.

This policy doesn’t apply to refill reminder programs (where you go in person to pick up the prescription) or long-term care pharmacies.

Note: Be sure to give your pharmacy the best way to reach you, so you don’t miss a refill confirmation call or other communication.

Contact your plan if you get prescriptions from a mail-order pharmacy that you didn’t approve or ask for. You may be eligible for a refund for the amount your plan charged you. If you aren’t able to resolve the issue with the plan or wish to file a complaint, call 1-800-MEDICARE.

What ID card should I use?

If you join a Medicare drug plan that works with Original Medicare: Use your drug plan ID card to fill your prescriptions. You’ll still use your Medicare card for hospital and doctor services, and for any prescription drugs covered under Part B.

If you join a Medicare Advantage Plan or other Medicare health plan with drug coverage: Use your plan ID card for all services, including prescriptions.

What if I’m taking a drug that isn’t on my plan’s drug list when my drug coverage begins?

Generally, your plan will give you a one-time, temporary supply of your current prescription drug during your first 90 days in a plan. Plans must give you this temporary supply so that you and your prescriber have time to find another drug on the plan’s drug list that will work as well as what you’re taking now. There may be different rules for people who move into or already live in a facility (like a nursing home or long-term care hospital).

You or your prescriber can contact the plan to ask for an exception if:

• You already tried similar prescription drugs on your plan’s drug list and they didn’t work.
• Your prescriber decides you need a certain drug because of your medical condition.
• Your prescriber thinks you need to have a coverage rule (like a prior authorization or quantity limit) waived.

Visit Medicare.gov/providers-services/claims-appeals-complaints/appeals/drug-plans to learn how to ask for an exception. If the plan agrees to your request, it will cover the drug. If your plan doesn’t agree to the exception, you can appeal the plan’s decision. Visit Medicare.gov/appeals for more information on appeals.

What if I join a plan, and then my doctor changes my prescription? Your doctor can check which drugs your plan covers and the plan’s coverage rules (like prior authorization, step therapy, and quantity limits) through their electronic prescribing system or the plan’s website.

If your doctor needs to prescribe a drug that isn’t on your Medicare plan’s formulary and you don’t have other coverage for outpatient prescription drugs, you or your doctor can ask the plan for an exception. Visit Medicare.gov/providers-services/ claims-appeals-complaints/appeals/drug-plans to learn how to ask for an exception.

If your plan still won’t cover a specific prescription drug you need, you can file an appeal. If you want to get the prescription drug before you file an appeal, you may have to pay out of pocket for the entire cost of the drug. Keep the receipt and give a copy of it to the person deciding your appeal. If you win the appeal, the plan will pay you back. For more information about appeals, visit Medicare.gov/appeals.

Call your plan or look on their website to find the most up-to-date list of covered drugs and what they cost, as well as the plan’s coverage rules like prior authorization, step therapy, and quantity limits.

Source and further reading

Your Guide to Medicare Prescription Drug Coverage — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.