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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 you do not receive more than a 30-day supply, and
  • If there is no network pharmacy that is close to you and open, or
  • If you need a drug that you can’t get at a network pharmacy close to you, or
  • If you need a drug for emergency or urgent medical care, or
  • If 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 will generally 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 (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.

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 Member Handbook or contact Member Services. We are here to help.

Information last updated: 07/11/2018