The Elder Advice Network
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Important information you need to know regarding Medicare prescription drug
and supply claims

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If you get Medicare covered prescription drugs or supplies, make sure your pharmacy or supplier is enrolled in the Medicare Program. If you go to a pharmacy or supplier that is not enrolled, Medicare will not pay. You will be responsible for paying the entire bill for any drugs or supplies. Ask the pharmacy or supplier if they are enrolled in the Medicare program.

For Medicare covered supplies, you should also find out if your pharmacy or supplier is participating with Medicare.

If they are participating, they must accept assignment. This means they must accept the Medicare-approved amount as payment in full. You should only pay your 20% co-pay (and any remaining Medicare Part B deductible) when you get your supplies.

If they are not participating, they do not have to accept assignment. This means that charges may be higher, and you may pay more. You may also have to pay the entire charge at the time of service, and wait for Medicare to send you its share of the charge.

All Medicare enrolled pharmacies and suppliers must submit claims for glucose monitor test strips. You will no longer be able to submit claims for glucose test strips.

For Medicare covered drugs and biologicals, it does not matter if your pharmacy is participating with Medicare. Under current law, all Medicare enrolled pharmacies must accept assignment for Medicare covered drugs and biologicals. If you purchase these items from a Medicare-enrolled pharmacy or supplier, you should only pay your 20% co-pay (and any remaining Medicare Part B deductible) when you get your prescriptions or supplies. Medicare will pay the remaining 80% directly to the pharmacy or supplier after they submit the claim.