Out-of-Network Pharmacies |
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 for our share of the cost.
How do you ask for reimbursement from us?
- Complete the Prescription Claim Form: Prescription Claim Form - English (PDF) | Prescription Claim Form - Spanish (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 Evidence of Coverage or contact Member Services. We are here to help.