Out of Network Coverage

We pay for drugs filled at an out-of-network pharmacy, only when you are not able to use a network pharmacy.  We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. We will pay for your drugs filled at an out-of-network pharmacy in the following cases:

  • When you are out of the area, require a prescription filled unexpectedly, and are unable to obtain medication at a network pharmacy
  • During a declared disaster in your service area. If you cannot use a network pharmacy during a declared disaster, you will be able to fill your prescription drugs at an out-of-network pharmacy.
  • 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.

In these situations, please check first with Member Services at 1-844-239-7387 to see if there is a network pharmacy nearby. Hours are from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day.

Will the plan pay you back for a prescription?

If you must use an out-of-network pharmacy, you will have to pay the full cost when you fill your prescription. You can ask us to pay you back for our share of the cost.

Last Updated: 09/30/16
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