Medicare

All of Eaton Apothecary's stores are located in Medicare Prescription Drug Plan Region 2, which includes Massachusetts, Vermont, Rhode Island and Connecticut. We accept, in all of our stores, all of the Region 2 plans EXCEPT those plans offered by Aetna. If the address on file with Medicare is in a Region 2 state, one must select a Region 2 plan. We take ALL of the plans that a Medicare beneficiary could have been automatically enrolled to.

Most people can only switch once per year — between November 15th and December 31st — 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.

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.

Does Eaton Apothecary bill my plan for a 90-Eaton Apothecary has a limited number of contracts that allow us to bill for up to a ninety-day supply at a time (for three copays). Those plans are:

- AdvantraRx
- Community Care Rx
- HealthNet Orange
- Prescription Pathway
- Silverscript
- Sterling Prescription Drug Plan

On plans not listed above, we, like many smaller pharmacies, have elected not to participate in the 90-day supply option for financial reasons. Please keep in mind that purchasing a ninety-day supply at a retail pharmacy will nearly always triple one's co-pay amount. This practice may cut down on trips to the pharmacy, but it may also lead to unused medications should changes in dose or drug occur down the roads. Also, our free home delivery service will cut your trips to the pharmacy down to zero.

 

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.

 

Yes, but the difference is usually zero or very small. In the majority of cases, the prices are the same at any retail pharmacy in the state. In some cases, copayments and co-insurance amounts can very by a few percentage points. In theory prices can vary in more significant amounts but such is quite rare for any drug that is covered by your plan as the plan sets the final price.

 

Every plan is different in how they determine this status; in many cases it is something as trivial as the date on which we signed a contract with the particular plan. For example, some plans will designate a pharmacy as 'preferred' if the provider contract is received early. What this designation does not in any way imply is that the level of service provided at a "preferred" pharmacy is in any way superior than at a "network" pharmacy. This designation may have a more significant meaning as Medicare Part D ages but for now it is largely irrelevant.

 

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.