Prescription Drug Discount Program for Medicare Recipients
- Prescription Drug Discount Program for Medicare Recipients (flyer)
- SB393 Background Information
- SB 393 Program Information for Pharmacies
California law enables Medicare recipients to obtain their prescription drugs at a cost no higher than the Medi-Cal price for those drugs.
Here’s how it works:
- You must have a Medicare card, and show it to the pharmacy staff.
- Give your prescription to the pharmacy staff, ask for the Medi-Cal prescription price, and ask if that is the lowest price the pharmacy will accept for the drug.
- If the Medi-Cal price is lower, you can pay that price, plus a small processing fee of $0.15, for the prescribed drug.
- You must pay for the prescription in full at the pharmacy: if you have prescription drug coverage, your insurance company is not eligible to receive the Medi-Cal price.
- Only Medi-Cal provider pharmacies are required by law to offer and accept the Medi-Cal price as payment for prescription medication for Medicare recipients. However, non-Medi-Cal pharmacies may also offer the Medi-Cal price if they choose.
Please note that obtaining prices from several pharmacies may help you find the lowest cost, but it’s best to get all your prescriptions from the same pharmacy. This way the pharmacist can record all the medications you are taking and what you are taking them for, and your pharmacist can tell you what to do if you have a bad reaction to a drug or find that a drug isn’t working. Also, the pharmacist can check your new prescription to make sure it won’t react badly with medicine you’re already taking. Proper pharmaceutical care can protect your health—or even save your life!
Frequently Asked Questions
What is the "Prescription Drug Discount Program for Medicare Recipients," and when did it begin?
It is a program that requires Medi-Cal provider pharmacies to charge Medicare recipients no more than the Medi-Cal price for their prescription drugs, plus a small processing fee. Specific Medi-Cal price rates can be obtained by the pharmacy via an online computer system. The program began February 1, 2000.
What is the "small processing fee," and what is it for?
The processing fee is $0.15 per prescription and is intended to reimburse the pharmacy for electronically checking Medi-Cal for prescription pricing information.
Who is eligible?
Anyone who has a Medicare card is eligible. That includes seniors over age 65 and those under age 65 who are disabled and have a Medicare card. You do not have to be on Medi-Cal.
Is Medi-Cal paying for my prescription?
No, Medi-Cal is not paying for the prescription. You, the Medicare recipient, are still responsible for paying for the prescription medication and the processing fee.
Do I have to fill out any forms to take advantage of the program?
No. All you need is your Medicare card.
How exactly does the program work?
When you give your prescription to the pharmacist, show the pharmacy staff your Medicare card, and request the Medi-Cal price rate. The pharmacist will electronically check Medi-Cal for the price of the prescribed drug, and you will be eligible to buy the drug at that price, plus the $0.15 fee.
How does the discount program work with telephoned prescriptions?
Ask the doctor’s office to advise the pharmacy that you are a Medicare patient when phoning in your prescription. Then show your card when you pick up your prescription. For future prescriptions, it is also a good idea to ask your regular pharmacy to note on your record that you are a Medicare recipient.
What drugs are covered?
Virtually every prescription medication is covered including both generic and brand name drugs; however, over-the-counter drugs and drugs that the pharmacist has to compound are not covered under this program.
Can I go to any pharmacy I want to get the Medi-Cal price?
Only Medi-Cal pharmacy providers are required to charge a Medicare recipient no more than the Medi-Cal prescription price; however, most pharmacies in California do participate in the Medi-Cal program. Ask your pharmacy if it is a Medi-Cal provider. Some non-Medi-Cal pharmacies may be willing to charge a similar prescription price.
How much money will I have to pay?
What you pay will depend on the medication, but it will not exceed the amount Medi-Cal pays the pharmacy for the medication, plus the $0.15 processing fee.
How much will I save?
Again, that will depend on the medication, as well as the quantity ordered and the drug manufacturer. The same drug may be manufactured by several companies, with each charging a different price.
How do I know I'm being charged the right amount?
Ask the pharmacist for a printout of the Medi-Cal information obtained through the pharmacy’s computer. Be sure to make this request when you hand your prescription to the pharmacy staff or when the doctor’s office calls in the prescription.
I have called four different pharmacies and have received four different prices. Why is that?
Prescription pricing can differ from pharmacy to pharmacy under this program. Most of the time this will occur because different drug manufacturers charge Medi-Cal different prices for the same drug.
I just refilled my prescription, and it cost more than last time, why?
Prescription drug manufacturers change their prices periodically. Price increases occur throughout the year, and for some drugs, many times during the year. Medi-Cal updates the prices it pays for drugs in its computer every month. If your prescription price does increase, you can ask your pharmacist if the manufacturer has increased the price.
If I already have prescription coverage, will this program affect me?
The program covers Medicare patients who themselves pay the full drug price. If you have prescription drug coverage through an insurance plan, your pharmacy is not required to charge the insurance company the Medi-Cal price, even if you are a Medicare patient. However, if you have prescription coverage, it might be advantageous to use the program if:
- You have reached your yearly or monthly prescription maximum paid amount under your insurance program and now have to pay full price for your prescriptions.
- Your prescription insurance doesn't cover a certain drug prescribed for you.
- You have a deductible to meet before your coverage begins.
Will this program affect my Medicare coverage?
No, this program does not affect your coverage under the Medicare program.
Can I receive the Medi-Cal price from my mail order pharmacy?
Yes, if that pharmacy is a Medi-Cal provider.
Who do I call if I believe the pharmacy is not charging me the right price, and I haven't been able to work it out with the pharmacy?
You can contact the California State Board of Pharmacy, Monday through Friday between the hours of 8 a.m. and 5 p.m. at (916) 518-3100.