Will Cost Plus Drugs Prescriptions Count Toward Medicare’s Drug Cost Cap?
Will Cost Plus Drugs Prescriptions Count Toward Medicare’s Drug Cost Cap?
By Sarah Wilczek, pharmacist at Network Health
6/3/2026
If you’re on Medicare, you’ve probably heard about the annual cap on prescription drug costs. In 2026, that cap is $2,100, but it can change each year. Put simply, this amount is the maximum amount you will have to pay for your prescriptions under your Medicare Part D benefit, as long as they are covered under your health plan’s formulary.
Where people get confused is when using online or mail-order pharmacies, such as Cost Plus Drugs. Cost Plus Drugs can be convenient and even save you money, but the process can be different from your traditional hometown pharmacy. Because of this, it may not be obvious whether or not your Cost Plus Drugs prescriptions count toward that drug cost cap if you’re on one of our Medicare Advantage plans.
How Cost Plus Drugs Fits In and Can You Use Insurance?
Cost Plus Drugs works much like any other in-network pharmacy. The key difference is instead of driving to the pharmacy to pick up your prescriptions, you get them delivered to your home. Additionally, Cost Plus Drugs prescriptions are managed online.
But what about insurance? You may have heard that you cannot use your health plan with Cost Plus Drugs, meaning that the money spent on prescriptions does not count toward deductibles, out-of-pocket maximums, etc. This may be true for some, but not for Network Health Medicare Advantage plan members. If you have such a plan with us, the money you spend on your medications through Cost Plus Drugs will count toward your Part D covered prescription cap.
But you have to make sure you’re using it correctly...
Specifically, you want to be sure to do two things:
- Add your Network Health plan information to your Cost Plus Drugs account
- Choose “request insurance pricing” at checkout.
If you do those two things, as long as it’s a covered prescription under your plan, it will function like any other pharmacy. The money you spend on those medications will then go toward your annual Part D covered prescription cap.
In What Cases Does Cost Plus Drugs Not Count Toward the Cap?
As you likely understand by now, your prescription costs through Cost Plus Drugs won’t count toward your cap if you don’t follow the steps we outlined previously. But there is another scenario where those costs won’t count, and that’s if you are getting a brand name medication.
On Cost Plus Drugs, if you’re getting a brand name medication, you can’t use insurance. The service is a great way to save money on generic medications, so if you want to learn about your options for generics instead of brand name, speak with your personal doctor. If you’re a Network Health member, you can also call our pharmacy team.
If the brand name medication is a necessity for you, a traditional pharmacy is usually the better option.
“I forgot to use insurance when checking out… Now what?”
If you forget to use your insurance when checking out or just didn’t know to “request insurance pricing” at checkout, there may still be a way to fix it. And this would work for any pharmacy you get your prescription from.
Our Network Health Medicare Advantage members who purchased medications without providing insurance information can fill out a reimbursement form through Express Scripts, Inc. (ESI).
Get the pharmacy reimbursement form here
So whether you’re on vacation, forgot to update your health plan information at your local pharmacy or didn’t add your request that insurance pricing on the Cost Plus Drugs website, this reimbursement options can be your safety net.
Mail-order pharmacy options like Cost Plus Drugs are new to many, especially if you have to go online. But we’re here to help. If you have a health plan with us, feel free to call our pharmacy team so we can assist with the process.
For personalized help with your Network Health plan, contact our pharmacist team.
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