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: 04/19/2018
We have thousands of pharmacies in our nationwide network to make it easy to get your drugs. We know there may be times when you can't use a network pharmacy. We may cover prescriptions filled at an out-of-network pharmacy:
- If you do not receive more than a 30-day supply, and
- If there is no network pharmacy that is close to you and open, or
- If you need a drug that you can’t get at a network pharmacy close to you, or
- If you need a drug for emergency or urgent medical care, or
- If you must leave your home due to a federal disaster or other public health emergency.
Always contact Member Services first to see if there is a network pharmacy close to you.
If you must use an out-of-network pharmacy, you will generally have to pay the full cost instead of a copay when you fill your prescription. You can ask us to pay you back for our share of the cost.
How do you ask us to pay you back?
- Complete the Prescription Claim Form – English (PDF) | Prescription Claim Form – Español (PDF)
- Attach the original prescription receipt to the form. If you do not have the original receipt, you can ask your pharmacy for a printout. Do not use cash register receipts.
- Mail the completed form and receipt to the address on the form.
After we receive your request, we will mail our decision (determination) with a reimbursement check (if applicable) within 14 days. For specific information about drug coverage, refer to your Member Handbook or contact Member Services. We are here to help.
Last updated: 10/04/2018