What Is Mail Order Pharmacy
A mail order pharmacy delivers prescription medications directly to your home, typically in 90-day supplies. You order through the mail, phone, or online rather than visiting a physical store. Your state Medicaid program or other government benefits may cover mail order prescriptions, sometimes at a lower copay than retail pharmacies.
How It Works With Government Benefits
If you receive Medicaid, your state determines whether mail order pharmacy is available and how it's covered. Most states require a 30-day supply for initial prescriptions but allow 90-day refills through mail order once your doctor approves the medication. Some states automatically route maintenance medications (drugs you take regularly) to mail order after the first or second fill at a retail pharmacy.
When you use mail order for Medicaid, your copay may be lower than retail. For example, a 30-day retail supply might cost $5, but a 90-day mail order supply could cost $10 total, reducing your monthly cost. Check your state's Medicaid pharmacy program guidelines, as coverage rules vary significantly.
SNAP, TANF, and WIC do not directly cover prescriptions, but if you qualify for these programs, you may also qualify for Medicaid, which does cover medications through mail order options.
Eligibility and Coverage
You can use mail order pharmacy if your health plan includes it. Most government-sponsored plans do, but coverage depends on your specific plan and whether the medication appears on your plan's formulary. Not all drugs qualify for mail order; some require monthly monitoring or dose adjustments that work better through retail pharmacies.
Your state Medicaid office determines mail order eligibility based on factors like whether you receive Supplemental Security Income (SSI) or cash assistance. Contact your state Medicaid agency to confirm your coverage before switching to mail order.
Advantages and Timing
- Lower copays for 90-day supplies compared to three separate 30-day retail fills
- Medications delivered to your home, eliminating trips to the pharmacy
- Automatic refills available for chronic condition medications
- Typically arrives within 7 to 14 business days after you order
Common Questions
- Will my Medicaid cover mail order if I move to a different state? No. Medicaid coverage changes when you move because each state administers its own program. You must reapply in your new state and may be on a waiting list. Notify your current state's Medicaid office at least 30 days before moving if possible.
- Can I use mail order if I'm on multiple government assistance programs? Possibly. Medicaid covers prescriptions regardless of whether you also receive SNAP, TANF, or WIC. However, income limits for Medicaid vary by state. Check your state's Medicaid eligibility thresholds, which typically range from 133% to 200% of federal poverty level depending on your category (adult, child, disabled, or pregnant).
- What happens if my mail order prescription is delayed? Contact the mail order pharmacy immediately. Most have emergency refill policies. If you run out before delivery, some states allow temporary retail fills that count toward your mail order authorization. Ask your Medicaid caseworker about emergency procedures in your state.