Out of State and Need a Prescription? Here's How Medicare Can Help

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Picture this frustrating but all-too-common scenario: You've safely made it to your vacation destination and are (finally) ready to throw on your bathing suit and join your grandkids at the pool. But as you start to unpack, you realize there's a big problem. You forgot your necessary medication.

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There's good news, though. Just because you're out of state doesn't mean you're out of luck. If you have Medicare prescription drug coverage through a Medicare Part D or Medicare Advantage plan, you'll likely be able to get your prescription at a pharmacy near your vacation spot.

We talked to Erin McKenna, Medicare chief pharmacy officer at Aetna, for her advice on what to know when needing a prescription away from home.

Know the pharmacies in your plan's network

Going to a pharmacy that's in your plan's network is the easiest, and often the cheapest, route to take when getting a prescription filled out of state. This is because many Medicare prescription drug plans have nationwide relationships with their in-network pharmacies. So, if a certain nationwide pharmacy is in your plan's network at home, then that same pharmacy will be still be in-network even if it's located in a different state.

"I live in Pittsburgh and go to a certain pharmacy here," McKenna says. "If I'm down in Florida for vacation and that certain pharmacy is also in Florida, it has the ability to fulfill my prescriptions as long as my Medicare prescription drug plan has a nationwide relationship with them."

If you aren't sure if your home pharmacy has a location in your vacation spot, call your plan. You should also call your plan to find out the specific details about your out-of-state prescription drug coverage.

Know what you're paying for

You're already going to be spending some cash during your vacation, so don't overpay for your prescriptions if you don't have to.

"Medicare prescription drug plans are required to charge you for the prescriptions you get at pharmacies. But that doesn't mean you have to pay a full one-month copay if you only need a two-week supply," says McKenna.

Purchasing only what you need can help you save money. McKenna says this is because some plans prorate what your cost share is. "This means, for example, if you have a $30 co-payment for a one-month supply of a medication and you're only going to get 10 days' worth of it, you're going to pay more like $10," she says.

As long as you're using the same pharmacy and aren't in a coverage gap, or "donut hole," with your Medicare prescription drug plan, you can also expect your prescriptions to cost about the same as they do at home.


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Know it could take time

Don't be surprised if the pharmacist in your vacation town has to get on the phone with your doctor in order to fulfill your request for a prescription. This is because pharmacy laws prevent us from getting too much of the same prescription at once.

"It's about safety. If you left a full, 90-tablet bottle at home and you just had that prescription filled, the pharmacist in your vacation town is going to see you're trying to refill a prescription too soon," says McKenna.

For maintenance medicines like diabetes or cholesterol medication, the pharmacist will have to call your doctor, explain the situation, and get their approval to provide you with the prescriptions you need for vacation.

Remember, all Medicare prescription drug plans are different, so it's important you call your plan to learn about your specific coverage. And if you ever do find yourself in need of a prescription away from home, don't hesitate to call your plan or your doctor for help.

Rachel Quetti is a health care writer at Aetna with experience in senior wellness, Medicare, commercial health care, and consumer engagement. When Rachel isn't trying out new fitness classes, she is cooking up fun, (mostly) healthy recipes in the kitchen. Rachel lives in Watertown, Massachusetts and has a degree in journalism from the University of Massachusetts, Amherst.