Which insurance program is typically billed first for pharmacy services?

Medicare is typically billed first for pharmacy services because it is a federally funded program designed primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities. In many cases, beneficiaries are instructed to utilize their Medicare Part D plan for prescription medications.

When a patient is enrolled in both Medicare and another form of insurance, the coordination of benefits generally dictates that Medicare acts as the primary payer. This means that any covered pharmacy services would first be processed through Medicare before any secondary insurance providers are billed.

It's important to understand how Medicare interacts with other forms of insurance. For example, while Medicaid may cover some pharmacy services for eligible patients, it often serves as a secondary payer when Medicare is involved. Additionally, private insurance plans and military programs like Tricare also have their established protocols for coordination, and typically secondary payers wait for Medicare to be billed first due to its primary status in most cases involving dual coverage.

Therefore, when evaluating which program should be billed initially for pharmacy services, Medicare is generally recognized as the primary option.