Prescription Drug Discount Program for Medicare Recipients

What is the "Prescription Drug Discount Program for Medicare Recipients," and when did it begin?

It is a program that requires Medi-Cal provider pharmacies to charge Medicare recipients no more than the Medi-Cal price for their prescription drugs, plus a small processing fee. Specific Medi-Cal price rates can be obtained by the pharmacy via an online computer system. The program began February 1, 2000.

What is the "small processing fee," and what is it for?

The processing fee is $0.15 per prescription and is intended to reimburse the pharmacy for electronically checking Medi-Cal for prescription pricing information.

Who is eligible?

Anyone who has a Medicare card is eligible. That includes seniors over age 65 and those under age 65 who are disabled and have a Medicare card. You do not have to be on Medi-Cal.

Is Medi-Cal paying for my prescription?

No, Medi-Cal is not paying for the prescription. You, the Medicare recipient, are still responsible for paying for the prescription medication and the processing fee.

Do I have to fill out any forms to take advantage of the program?

No. All you need is your Medicare card.

How exactly does the program work?

When you give your prescription to the pharmacist, show the pharmacy staff your Medicare card, and request the Medi-Cal price rate. The pharmacist will electronically check Medi-Cal for the price of the prescribed drug, and you will be eligible to buy the drug at that price, plus the $0.15 fee.

How does the discount program work with telephoned prescriptions?

Ask the doctor’s office to advise the pharmacy that you are a Medicare patient when phoning in your prescription. Then show your card when you pick up your prescription. For future prescriptions, it is also a good idea to ask your regular pharmacy to note on your record that you are a Medicare recipient.

What drugs are covered?

Virtually every prescription medication is covered including both generic and brand name drugs; however, over-the-counter drugs and drugs that the pharmacist has to compound are not covered under this program.

Can I go to any pharmacy I want to get the Medi-Cal price?

Only Medi-Cal pharmacy providers are required to charge a Medicare recipient no more than the Medi-Cal prescription price; however, most pharmacies in California do participate in the Medi-Cal program. Ask your pharmacy if it is a Medi-Cal provider. Some non-Medi-Cal pharmacies may be willing to charge a similar prescription price.

How much money will I have to pay?

What you pay will depend on the medication, but it will not exceed the amount Medi-Cal pays the pharmacy for the medication, plus the $0.15 processing fee.