Out of Network Coverage

In most cases, the plan will pay for prescriptions only if they are filled at the plan’s network pharmacies. A network pharmacy is a drug store that has agreed to fill prescriptions for our plan members. You may go to any of our network pharmacies.

If you go to an out-of-network pharmacy, you will have to pay the full cost of your prescription. We may consider coverage for prescriptions filled at out-of-network pharmacies. Send us a copy of your receipt when you ask us to pay you back.

When you are not able to use a network pharmacy we will pay for your drug in the following cases:

  • When you are out of the area and are unable to obtain your medication at a network pharmacy.
  • During a declared disaster in your service area and you cannot use a network pharmacy.
  • Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available, up to a 30-day supply.

To find a network pharmacy, you can look in the Provider and Pharmacy Directory, Find a Doctor or Pharmacy tool on our website, or contact Member Services or your Service Coordinator.

Call Member Services at 1-866-896-1844 to see if there is a network pharmacy nearby. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

 

Last Updated: 09/30/2017
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