Prescription Drug Discount Program for Medicare Recipients
California law enables Medicare recipients to obtain their prescription drugs at a cost no higher than the Medi-Cal price for those drugs.
Here’s how it works:
- You must have a Medicare card, and show it to the pharmacy staff.
- Give your prescription to the pharmacy staff, ask for the Medi-Cal prescription price, and ask if that is the lowest price the pharmacy will accept for the drug.
- If the Medi-Cal price is lower, you can pay that price, plus a small processing fee of $0.15, for the prescribed drug.
- You must pay for the prescription in full at the pharmacy: if you have prescription drug coverage, your insurance company is not eligible to receive the Medi-Cal price.
- Only Medi-Cal provider pharmacies are required by law to offer and accept the Medi-Cal price as payment for prescription medication for Medicare recipients. However, non-Medi-Cal pharmacies may also offer the Medi-Cal price if they choose.
Please note that obtaining prices from several pharmacies may help you find the lowest cost, but it’s best to get all your prescriptions from the same pharmacy. This way the pharmacist can record all the medications you are taking and what you are taking them for, and your pharmacist can tell you what to do if you have a bad reaction to a drug or find that a drug isn’t working. Also, the pharmacist can check your new prescription to make sure it won’t react badly with medicine you’re already taking. Proper pharmaceutical care can protect your health—or even save your life!
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?
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?
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?
Medi-Cal is not paying for the
prescription. You, the Medicare recipient,
are still responsible for paying for
the prescription medication and the processing
Do I have to fill out any forms to take advantage of the program?
All you need is your Medicare card.
How exactly does the program work?
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
How does the discount program work with telephoned prescriptions?
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
What drugs are covered?
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?
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
How much money will I have to pay?
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.
How much will I save?
that will depend on the medication, as
well as the quantity ordered and the
drug manufacturer. The same drug may
be manufactured by several companies,
with each charging a different price.
How do I know I'm being charged the right amount?
the pharmacist for a printout of the
Medi-Cal information obtained through
the pharmacy’s computer. Be sure to make
this request when you hand your prescription
to the pharmacy staff or when the doctor’s
office calls in the prescription.
I have called four different pharmacies and have received four different prices. Why is that?
pricing can differ from pharmacy to pharmacy
under this program. Most of the time
this will occur because different drug
manufacturers charge Medi-Cal different
prices for the same drug.
I just refilled my prescription, and it cost more than last time, why?
drug manufacturers change their prices
periodically. Price increases occur throughout
the year, and for some drugs, many times
during the year. Medi-Cal updates the
prices it pays for drugs in its computer
every month. If your prescription price
does increase, you can ask your pharmacist
if the manufacturer has increased the
If I already have prescription coverage, will this program affect me?
program covers Medicare patients
who themselves pay the full
drug price. If you have prescription
drug coverage through an insurance
plan, your pharmacy is not required
to charge the insurance company the
Medi-Cal price, even if you are a
Medicare patient. However, if you
have prescription coverage, it might
be advantageous to use the program
- You have reached your yearly or monthly prescription maximum paid amount under your insurance program and now have to pay full price for your prescriptions.
- Your prescription insurance doesn't cover a certain drug prescribed for you.
have a deductible to meet before
your coverage begins.
Will this program affect my Medicare coverage?
this program does not affect your coverage
under the Medicare program.
Can I receive the Medi-Cal price from my mail order pharmacy?
Yes, if that
pharmacy is a Medi-Cal provider.
Who do I call if I believe the pharmacy is not charging me the right price, and I haven't been able to work it out with the pharmacy?
You can contact the California State Board of Pharmacy, Monday through Friday between the hours of 8 a.m. and 5 p.m. at (916) 574-7900.