A mail order pharmacy delivers a multi-month supply of prescription medications directly to a patient’s home. This service is typically used for maintenance drugs taken regularly for long-term conditions like high blood pressure or diabetes. Beneficiaries often use this method for convenience and potential cost savings associated with receiving a 90-day supply. The federal Medicare program does not operate a pharmacy, so the specific mail order provider is determined entirely by the individual’s private insurance plan.
The Relationship Between Medicare and Pharmacy Networks
The original Medicare program (Part A and Part B) does not directly manage prescription drug benefits. Coverage is administered through private insurance companies offering either stand-alone Prescription Drug Plans (Medicare Part D) or comprehensive Medicare Advantage Plans (Part C) that include drug coverage. The private plan chosen by a beneficiary dictates the entire pharmacy network they must use, including the mail order option.
Private plans contract with Pharmacy Benefit Managers (PBMs) to manage their drug benefits. The PBM acts as an intermediary, handling administrative tasks, negotiating drug prices, and determining the network of pharmacies, including the mail order facility. The mail order pharmacy is a service provided through the PBM that the plan contracts with, not the federal Medicare program. This structure means that a beneficiary’s mail order provider changes if they switch to a different Part D or Medicare Advantage plan during the annual enrollment period.
Identifying Your Plan’s Specific Mail Order Provider
To determine the required mail order pharmacy, consult the official documentation provided by your specific plan. Your plan’s Summary of Benefits or Evidence of Coverage document details the pharmacy network and any preferred mail order service. The plan’s formulary, the list of covered drugs, often specifies whether a medication is eligible for mail order fulfillment.
A practical step is to call the customer service number on your insurance card. A representative can confirm the name of the mail order provider associated with your benefits. Many plans also offer an online pharmacy locator tool on their member website to identify the approved mail order facility and provide instructions for submitting a prescription.
Major Pharmacy Benefit Managers Operating in Medicare
The mail order service used by your plan is managed by a Pharmacy Benefit Manager (PBM). The PBM market is highly concentrated, with a small number of large companies processing the vast majority of prescription claims, including those for Medicare Part D. These companies operate the mail order pharmacies under their own corporate names.
The three largest PBMs are deeply involved in the Medicare space and often own and operate the mail order facilities designated by multiple insurance companies. These major entities include:
- CVS Caremark, which manages mail order services for various insurance companies affiliated with its parent organization, CVS Health, and many other clients.
- Express Scripts, a subsidiary of Cigna’s Evernorth, which manages prescription benefits and mail order fulfillment for a significant portion of the Medicare population.
- OptumRx, part of UnitedHealth Group, which provides mail order services to millions of beneficiaries enrolled in the plans it serves.
Starting and Managing Mail Order Prescriptions
Starting the service involves getting a prescription for a long-term maintenance medication authorized for a 90-day supply. The most efficient way to initiate an order is by asking your prescribing physician to send an electronic prescription (e-prescribing) directly to the designated mail order pharmacy. The doctor will need the specific electronic identification number for the PBM’s mail order facility.
Alternatively, you can contact the mail order provider directly online, through a mobile application, or by phone, and they will coordinate with your doctor to obtain the necessary authorization. For the initial order, place the request at least two weeks before your current supply runs out to allow time for processing and shipping. Most PBM mail order services allow for automatic refills, simplifying the management of long-term medications.