Medicare Pharmacy Directory

When You Can Use an Out-of-Network Pharmacy

Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

• Prescriptions you get in connection with covered emergency care up to a 10-day supply.
• Prescriptions you get in connection with covered urgently needed care when network providers are not available up to a 10-day supply.

The pharmacy network may change at any time. You will receive notice when necessary. In these situations, please check first with Health Plan Services to see if there is a network pharmacy nearby.

How do you ask for reimbursement from the plan?

If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost. (Chapter 7, Section 2.1 in your Evidence of Coverage explains how to ask the plan to pay you back.)