Reference Information for Answers

Question 1.  Section 423.120 (a)(1) and (3) of the MMA Regulations addresses the topic of mail-order pharmacies.

Access to covered Part D drugs.  (a) Assuring pharmacy access.
(1) Standards for convenient access to network pharmacies. Except as provided in paragraph (a)(7) of this section, a Part D plan must have a contracted pharmacy network consisting of retail pharmacies sufficient to ensure that for beneficiaries residing in each State in a prescription drug plan’s service area (as defined in § 423.112(a)), each State in a regional MA-PD plan’s service area (as defined in § 422.2 and § 422.455(a) of this chapter), a local MA-PD plan’s service area (as defined in § 422.2 of this chapter), or a cost plan’s geographic area (as defined in § 417.401 of this chapter), the following requirements are satisfied:
(i) At least 90 percent of Medicare beneficiaries, on average, in urban areas served by the Part D plan live within 2 miles of a network pharmacy that is a retail pharmacy or a pharmacy described under paragraph (a)(2) of this section;
(ii) At least 90 percent of Medicare beneficiaries, on average, in suburban areas served by the Part D plan live within 5 miles of a network pharmacy that is a retail pharmacy or a pharmacy described under paragraph (a)(2) of this section; and
(iii) At least 70 percent of Medicare beneficiaries, on average, in rural areas served by the Part D plan live within 15 miles of a network pharmacy that is a retail pharmacy or a pharmacy described under paragraph (a)(2) of this section.
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(3) Access to non-retail pharmacies. A Part D plan’s contracted pharmacy network may be supplemented by nonretail pharmacies, including pharmacies offering home delivery via mail-order and institutional pharmacies, provided the requirements of paragraph (a)(1) of this section are met.

Question 2.  Section 423.120(a)(10) of the MMA Regulations states that,

(10) Level playing field between mail-order and network pharmacies.
A Part D sponsor must permit its Part D plan enrollees to receive benefits, which may include a 90-day supply of covered Part D drugs, at any of its network pharmacies that are retail pharmacies. A Part D plan may require an enrollee obtaining a covered Part D drug at a network pharmacy that is a retail pharmacy to pay any higher cost-sharing applicable to that covered Part D drug at the network pharmacy that is a retail pharmacy instead of the cost-sharing applicable to that covered Part D drug at the network pharmacy that is a mail-order pharmacy.

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