Out-of-network Pharmacy Coverage
Get to know the extent of your plan’s coverage of prescription medicine purchase outside of the pharmacy network.
Usually, we only cover drugs obtained from an out-of-network pharmacy in limited circumstances:
When you travel out of the plan’s service area.
If you lose or you lack your medication, or get sick and need a covered drug immediately and you do not have access to a network pharmacy.
If you cannot obtain a covered drug in your service area in a timely manner due to lack of availability of a network pharmacy.
If your covered drug is provided in an out-of-network pharmacy while you are in an emergency room, in a provider’s clinic, outpatient surgery, or in another facility.
If a covered prescription is not in inventory at an accessible in-network retail pharmacy.
For detailed information consult your plan’s Evidence of Coverage (Chapter 5, Using the plan’s coverage for your Part D prescription drugs, Section 2.4 “When can you use a pharmacy that is not in the plan’s network?”) or call our Member Services.
Please note that if you do go to an out-of-network pharmacy, you may have to pay the full cost (rather than paying just your copay) when you fill your prescription. You can request a reimbursement for our share of the cost by submitting a claim form. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy, as any amount you pay will help you qualify for catastrophic coverage.
Request guidance
Fill in your information and one of our sales representatives will call you.
The Centers for Medicare & Medicaid Services (CMS) require agents to document the scope of the marketing appointment before the in-person sales meeting, to ensure it is understood what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and must be completed by each person who has Medicare or their authorized representative. By signing this form, you are accepting a sales appointment or a call from one of our sales representatives to discuss the specific products you selected above. The person who will discuss plan options with you is an employee of, or contracted by, a Medicare Health Plan that is not part of the Federal Government, and may be compensated based on your enrollment in a plan. This is not an enrollment request. Signing this form does NOT affect your current contract, nor will it enroll you in a Medicare Advantage or other Medicare plan.