People With Medicare
Questions about getting drugs while in a nursing home
Will I be able to get my drugs while I am in a nursing home?The plan must give the same list of covered drugs to everyone who joins the plan. You will be able to get the same drugs if you are living at home or in the nursing home.
What happens if some of my drugs are not on the plan's drug list?If the Medicare drug plan that you choose does not cover some of the drugs you take, you will have three choices:
- You can switch to drugs that your plan covers. Your doctor and the pharmacist at your nursing home will work to switch you to medications that your plan covers.
- You can ask the plan for an exception, or special permission, if your doctor wants you to have certain drugs for medical reasons. You would ask your plan to make an exception and cover the drug for you (see Exceptions to the Limits).
- You can pay for your drugs out of your pocket. This is the last option. Medicare strongly encourages you to ask for an exception.
What about over-the-counter medications-do the Medicare drug plans pay for them?You do not need a prescription for some drugs. These are called over-the-counter (OTC) drugs. Examples are.phpirin, acetaminophen, some allergy medications and drugs for heartburn. Medicaid and Medicare Part A pay for these drugs.
The Medicare Prescription Drug Coverage only pays for prescription drugs. It does not pay for over-the-counter drugs. If Medicaid or Medicare Part A does not cover your over-the-counter drugs, you would have to buy them yourself.
If you have Medicaid, it may cover over-the-counter drugs. If your state Medicaid pays for these drugs for other people on Medicaid, they will pay for yours too. You would need to ask your social worker at your nursing home or State Health Insurance Assistance Program (SHIP) for more information.