PharmacyCard.org is the leading discount card in overall savings with an average discount typically around 60% and over 63,000 participating pharmacies. We do feel as though we have an obligation to give an honest opinion as to how these cards should be used in the assisted living facility environment. We know PharmacyCard.org can help your residents save money but we also want to make sure it is done in the right way and to the benefit of the resident.
Some of residents in assisted living facilities have Medicare Part D coverage, others have private or no prescription insurance. Each resident and their families understand that good planning is needed to meet all the resident’s prescription needs. For those individuals with Medicare Part D, this can get little confusing.
While a Medicare beneficiary could use the PharmacyCard.org Prescription Savings Card at any time, they would not get credit for those prescriptions purchased using the Card unless it was during their deductible phase or the coverage gap (donut hole) and they mail in receipts to their Part D plan. The fact is that most people won’t remember to mail in copies of their prescription receipts, meaning they will not get credit for those prescription purchases and will not leave the coverage gap for that year.
In general, we do not recommend Medicare Part D beneficiaries using the Savings Card. However, here are the exceptions where a Medicare Part D beneficiary using the Savings Card might be appropriate:
- Use the Savings Card for prescriptions that are not covered on their Part D plan. Approximately 35% of prescriptions are not covered on formularies.
- Use during the deductible phase if the card gives a better price than the Part D plan. Beneficiary must mail receipts to their Part D plan. Only valid at pharmacies contracted with their Part D plan.
- Use once a beneficiary has reached the coverage gap and they will not leave the gap before the end of the plan year (December 31). Ask the pharmacy to check whether the Part D plan or the Savings Card gives them the best price.
The key to using this card for Medicare Part D residents is record keeping. The discount card is not connected with the insurance plan and therefore the record of the prescription purchase is not reported to the insurance company. It is your responsibility and that of the patient to retain the purchase receipts of the prescriptions and sends copies of these to the insurance plan. This is a simple process but if the records are not maintained and easily obtained, the resident will not be able to get out of the donut hole.