Question: Can I use my Medicare Part D prescription drug coverage when traveling outside of my home state?
Yes. You can use your Medicare Part D prescription drug plan at any one of your plan’s network pharmacies across the country, and most Medicare prescription drug plans include 50,000 to 65,000 (or more) pharmacies in their network. Here are a few additional reminders about using a network pharmacy as you travel within the United States:
(1) You may pay more for your formulary drugs at a standard network pharmacy.
Please remember that your Medicare Part D plan may charge higher copayments at standard network pharmacies as compared to “preferred network” pharmacies.
(2) You may pay more (or less) for your formulary drugs as you travel since retail drug prices can vary between network pharmacies.
Please remember that retail drug prices can vary from pharmacy-to-pharmacy. So if your drug coverage is based on coinsurance (you pay a percentage of the retail cost – such as 25% of retail) – or you are in the Donut Hole – or in the
2023 Catastrophic Coverage phase you may find that you pay different prices at different pharmacies – although the pharmacies are still part of your Medicare Part D plan’s pharmacy network (or preferred pharmacy network).
Keep in mind that 2023 is the last year that Medicare Part D beneficiaries will pay cost-sharing in the Catastrophic Coverage phase. For plan year 2024 and beyond, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing in the Catastrophic Coverage phase, so plan members will not have any out-of-pocket costs for formulary drugs after reaching the plan’s 2024 $8,000 total out-of-pocket threshold (TrOOP); therefore, TrOOP becomes the RxMOOP in 2024.
Question: How do we find a network pharmacy when we are in an unfamiliar area?
If your travels take you to a remote or unfamiliar area of the country, and you are having trouble finding a network pharmacy or preferred network pharmacy, you can always telephone your Medicare Part D plan’s Member Services department and ask them to help you find the nearest pharmacy. The toll-free number for Member Services is located on your Member ID card and most of your plan’s printed information.
If you cannot find your Member ID card or your Medicare plan’s contact information, you can telephone Medicare at 1-800-633-4227 and ask a Medicare representative to help find your plan’s contact information.
If you prefer to search for pharmacies and/or providers online, you can use our pharmacy and provider search tool articles for instructions and links to the online tools for a few of the more popular Medicare plans.
When all else fails: Asking for reimbursement when no network pharmacy is available
If, in the unlikely event that you find no network pharmacy in some area of the country, you should be able to purchase medications at a non-network pharmacy and submit the receipts to your Medicare plan for reimbursement. (You can also telephone your plan’s Member Services department to learn about the reimbursement process – the telephone number is on your Member ID card.)
Traveling when you have drug coverage through your Medicare Advantage plan
If you receive your Medicare Part D prescription drug coverage through a Medicare Advantage plan that includes prescription drug coverage (also called an MAPD), you will find that your MAPD has the same generous number of network pharmacies across the country (50,000 to 65,000 pharmacies) and you should be able to find a network pharmacy as you travel.
As a note, depending on your Medicare Advantage plan, you may pay higher out-of- network copayments for other healthcare needs (like doctor or hospital visits) as you travel away from home and outside of your Medicare Advantage plan’s established healthcare network or service area.