Pharmacy Networks

Our members have access to many pharmacy resources and services. Explore the following information to learn about in-network and out-of-network pharmacies, specialty pharmacies, mail order service, prescription reimbursement and more.

• Find a Provider/Pharmacy
• Network Pharmacies
• Specialty Pharmacy
• Out-of-Network Pharmacies
• Mail Order Service
• Out-of-Network Pharmacies
• Prescription Reimbursement
• Pharmacy Directory

In-Network Pharmacies

You can fill your prescriptions at any pharmacy in our nationwide network. This includes many major retail chains and independent pharmacies. Our network also includes mail order pharmacies, long‑term care pharmacies, home infusion services, and Indian Health Service, Tribal, and Urban Indian Health programs.

To fill a prescription, ask your prescriber to send it to the network pharmacy of your choice. When you arrive at the pharmacy, present your Member ID card. If your card is not available, you can access your ID card online through the Member Portal.

Find a network pharmacy near you by using the Find a Provider/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please contact Member Services.

For more information about filling your prescriptions at network pharmacies, please refer to your Evidence of Coverage (EOC) or contact Member Services.

Specialty Pharmacy

Our specialty pharmacies are available at no extra cost to members taking drugs used to treat long-term, complex, or rare chronic conditions such as cancer, rheumatoid arthritis, H.I.V. or hemophilia. Specialty pharmacies can help you to manage side effects and symptoms, ensure you take your medications on time and as prescribed, and assist you with refills.

• AcariaHealth Pharmacy: 1-855-535-1815 (TTY: 711)
• Accredo Health Group: 1-833-750-9975 (TTY: 711)
• CVS Caremark Specialty Pharmacy: 1-800-237-2767 (TTY: 711)
• Walgreens Specialty Pharmacy: 1-888-782-8443 (TTY: 711)

Other in-network specialty pharmacies may be available depending on your plan. Find a network pharmacy near you by using our Find a Provider/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please contact Member Services.

Not all specialty pharmacies carry every drug. What they offer depends on the drug and your plan. Before you transfer or fill a new prescription, call the specialty pharmacy you choose to confirm they can fill your prescription.

For more information on our specialty pharmacies, please refer to your Evidence of Coverage or contact Member Services.

Out-of-Network Pharmacies

We have thousands of pharmacies in our nationwide network to make it easy to get your prescription drugs. Using a network pharmacy is usually the best option to lower costs and reduce paperwork.

However, we know there may be times when you can't use a network pharmacy. We may cover your prescription filled at an out-of-network pharmacy if:

• There isn't a 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 or use the Find a Provider/Pharmacy tool to check if there is a network pharmacy near you.

Traveling or Away from Home

If you take a prescription drug on a regular basis and are planning to travel, be sure to check your supply before you leave. When possible, bring all the medications you will need for your trip. If you travel within the United States and territories, we may cover your drug at an out-of-network pharmacy for the same reasons as noted previously. However, we cannot pay for any prescriptions filled outside of the United States and its territories, including prescriptions filled while traveling on cruises, even for a medical emergency.

If you use an out‑of‑network pharmacy, you may need to pay the full cost of your prescription at the time of purchase. You can then ask us to pay you back for our share of the cost. Approval is not guaranteed.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please contact Member Services or refer to your Evidence of Coverage/Member handbook for more information, including the cost-sharing that applies to out-of-network services.

Prescription Reimbursement

If you need to ask us to pay you back for prescriptions paid out of pocket:

1. Complete the Prescription Drug Claim Form using the following links.
   • Prescription Drug Claim Form – English (PDF)
   • Prescription Drug Claim Form – En Español (Spanish) (PDF)
2. If you want another person to complete this form on your behalf, please include the Appointment of Representative (AOR) Form CMS-1696 with your Prescription Drug Claim Form. This form is located at the following links, and can also be found on the Centers for Medicare & Medicaid Services (CMS) website.
   
   
   • Appointment of Representative AOR Form CMS-1696 - English (PDF)
   • Appointment of Representative AOR Form CMS-1696 - En Español (Spanish) (PDF)
3. Add the prescription label information to the form and include a proof of payment receipt with each claim form you submit. If you do not have the receipt or the information needed to fill out the form, you can ask your pharmacy to help.
4. Mail the completed form(s) and receipt(s) to the address on the form. You must submit your claim to us within three years of the date you received your drug.
5. It is also a good idea to keep a copy of the forms and receipts for your records.

After we receive your request, we will mail our decision (coverage determination) with a reimbursement check (if applicable) within 14 days.

For specific information about drug coverage, please refer to your Evidence of Coverage or contact Member Services. We are here to help.

Mail Order Service

You can fill your prescription at any network pharmacy. You can also fill your prescription through our preferred mail order service Express Scripts. This can save you time, money, and trips to the pharmacy.

Find more information about receiving your prescriptions through mail service delivery on the Mail Order Service page.

For additional information about in-network drug coverage, using an out-of-network pharmacy, specialty pharmacy, mail order service, prescription claims, or using our Find a Provider/Pharmacy tool, please refer to your Evidence of Coverage/Member Handbook or contact Member Services. We are here to help.