What if I need to use an out-of-network pharmacy?
If you cannot use a network pharmacy, there are special circumstances when our plan will cover prescriptions filled by an out-of-network provider or pharmacy:
- Part D Vaccines administered in a clinic or hospital setting which are considered out-of-network.
- Part D drugs which cannot be obtained from a network pharmacy in a timely manner, such as no network pharmacy available in a reasonable driving distance or that provides 24-hour, 7-day a week service.
- Part D drugs, which are not obtainable at a network pharmacy, because they are only available from specialty pharmacies or typically shipped directly from the manufacturer.
- Part D drugs dispensed while in an emergency department, provider-based clinic, or an outpatient setting and a network pharmacy was unavailable.
- Part D drugs dispensed from an out-of-network pharmacy while you are using the plan's visitor/travel benefit.
- During any federal disaster declaration or other public health emergency declaration in which you are evacuated or displaced.
In these situations, please check first with Customer Service to
see if there is a network pharmacy nearby. You may be required to pay the difference between what you pay for the drug at the out-of-network pharmacy and the cost that we would cover at an in-network pharmacy.
We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency or urgent care.