Resident pharmacy charges depend upon the characteristics of the resident’s payor (insurance) coverage, such as:
Medicare Part A
In general, the facility is responsible for pharmacy charges.
Prescribed drugs. Most of the drugs that are prescribed by your doctor are covered by the Medicaid Program. Drugs sold over-the-counter must be prescribed by your doctor to be covered. Some drugs have limits and some may require prior approval.
Dually Eligible (Medicare Part D and Medicaid)
If the resident is Dual Eligible, meaning the resident has both Medicare Part D and Medicaid, the resident should have $0 co-pay unless the medication is just not covered. The Power of Attorney needs to contact the Social Worker who signed the resident up with the Part D plan and Medicaid to make sure the system reads the resident as residing in a SNF.