Medicare

All of Eaton Apothecary's pharmacy are located in Medicare Prescription Drug Plan Region 2, which includes Massachusetts, Vermont, Rhode Island and Connecticut. If the address on file with Medicare is in a Region 2 state, one must select a Region 2 plan. We accept most plans and networks but please consult medicare.gov or the plan for a conclusive determination

Most people can only switch once per year — between October 15th and December 7th — during the annual open-enrollment period. Those people who have both Medicare and Medicaid (MassHealth) may however switch plans once per month with the change taking effect the first of the following month. Changes and enrollments may be made through Medicare.gov or by calling the plan one wishes to select. For more information, consult Medicare.gov

Eaton Apothecary is forbidden by federal law from making recommendations regarding what plan to select. Medicare.gov has a plan finder tool that allows entry of one's medications and dosages in order to select a financially appropriate plan. If requested, we can provide a listing of all medications received within the past year to aid you in this process. Keep in mind when selecting a plan that the number of prescriptions one is taking will usually increase over time and that antibiotics and other short-term medications will likely be needed during the year.

Eaton Apothecary has a limited number of contracts that allow us to bill for up to a ninety-day supply at a time (usually for three copays). If your prescriber writes for a 90 day supply we can attempt to bill for that quantity and, if not covered, reduce to the amount allowed by the plan

 

All plans must have an exceptions process that involves the doctor submitting a letter of medical necessity (or other documentation as required by the plan) to the plan. The plan then reviews the request and makes a decision on whether it will be covered. This process usually takes a few days but once the plan receives the documentation required they must make their decision within 72 hours. Exceptions are granted regularly for good reasons but the copayment level will usually be the highest one the plan has. One's first reaction to having a drug not covered should not be "how do I get this covered "but rather "what is covered" as all plans must cover at least two drugs from each therapeutic class. Only your doctor can decide what medication is appropriate for you, but we can usually tell you what medications are covered before you speak with your doctor.

 

After we bill your Medicare Part D Plan, we will automatically bill your Prescription Advantage secondary plan for the balance. Depending on the plan structure, you may be entitled to a lower copayment — never higher. We are able to bill both in tandem so that the amount you are charged reflects this dual-billing.

 

Yes! Please present all Medicare Part D cards as well as all cards for secondary prescription coverage that you may have. After we have entered your card into the system we will continue to bill it going forward. If at any time you receive a new card please show us; often times there are subtle differences on these cards that make a world of difference.

 

Under Massachusetts Law, we must provide a generic drug to you automatically if one is available and the doctor did not write the words "No Substitution" on the prescription. Whenever an equivalent generic exists, we will give it to you automatically — no need to ask like in some other states. There may be some "similar" but not direct equivalent generics available to branded drugs that you are taking. If you are on an expensive drug, ask your doctor or your Eaton Apothecary pharmacist if there may be something similar that could be considered.

 

Every plan is different in how they determine this status and what it means. Some plans have "Preferred" pharmacies where members can obtain lower copayments or co-insurance. Preferred networks are typically restricted to a very limited number of pharmacies. Others may not use the distinction for any pharmacies.

 

The patient cost sharing amount (copayment) is required under the Medicare Modernization Act that created Medicare Part D. Eaton Apothecary is obligated to collect this amount from the Medicare beneficiary at the point of service by law and by its contractual obligations to each and every one of the Part D plans. If you have difficulty paying for your prescriptions, there are a number of public and private programs in existence to assist you; simply call 800-MEDICARE or ask your Eaton Apothecary pharmacist for guidance.

 

People who have both Medicare and MassHealth ("dual-eligibles") are subject to the formulary of their Medicare Part D Plan for every category of drugs that is covered by the Part D Plan. Within each category of drugs covered by your Medicare plan not all individual drugs are covered. MassHealth covers only specific items within these categories too. For any common category, the dual-eligible is only permitted to select from those offered by the Medicare Part D plan. If the dual-eligible needs something not covered by the Medicare Part D Plan, an exception must be requested from the Medicare Part D Plan. MassHealth coverage is only available to be used for drugs in the categories where in the Medicare Part D Plan covers no drugs at all.