Out of Network Pharmacies
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:
- There is no network pharmacy that is close to you and open, or
- You need a drug that you can't get at a network pharmacy close to you, or
- You need a drug for emergency or urgent medical care, or
- 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 generally will have to pay the full cost instead of a copay when you fill your prescription. You can ask us to pay you back (reimbursement) for our share of the cost.
How do you ask for reimbursement from us?
- Complete the prescription claim form
- 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 Evidence of Coverage or contact Member Services. We are here to help.
- Employer Plans - Medicare
- Drug and Pharmacy Information
- Transitions of Prescription Drugs
- Prior Authorizations, Step Therapy and Quantity Limits
- Find a Pharmacy
- Mail Order Pharmacy
- Out-of-Network Pharmacies
- Medication Therapy Management Program (MTMP)
- Medication Adherence and Quality Assurance
- Coverage Determinations/ Drug Exceptions and Appeals
- List of Drug Changes