Our members have access to many pharmacy resources and services. Explore the information below to learn about in-network and out-of-network pharmacies, specialty pharmacies, mail order service, prescription reimbursement and more.
Find a Provider/Pharmacy
Network Pharmacies
Specialty Pharmacy
Out-of-Network Pharmacies
Mail Order Services
Prescription Reimbursement
Pharmacy Directory
In-Network Pharmacies
You can fill your prescriptions at any pharmacy in our nationwide network. This includes many major retail chains and independent pharmacies. Our network also includes mail order pharmacies, long term care pharmacies, home infusion services, and Indian Health Service, Tribal, and Urban Indian Health programs.
To fill a prescription, ask your prescriber to send it to the network pharmacy of your choice. When you arrive at the pharmacy, present your Member ID card. If your card is not available, you can access your ID card online through the Member Portal.
Find a network pharmacy near you by using the Find a Provider/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please Contact Us.
For more information about filling your prescriptions at network pharmacies, please refer to your Evidence of Coverage or Contact Us.
Farmacia Especializada
Our specialty pharmacies are available at no extra cost to members taking drugs used to treat long-term, complex, or rare chronic conditions such as cancer, rheumatoid arthritis, H.I.V. or hemophilia. Specialty pharmacies can help you to manage side effects and symptoms, ensure you take your medications on time and as prescribed, and assist you with refills.
- AcariaHealth Pharmacy: 1-855-535-1815 (TTY: 711)
- Accredo Health Group: 1-833-750-9975 (TTY: 711)
- CVS Caremark Specialty Pharmacy: 1-800-237-2767 (TTY: 711)
- Walgreens Specialty Pharmacy: 1-888-782-8443 (TTY: 711)
Other in-network specialty pharmacies may be available depending on your plan. Find a network pharmacy near you by using our Find a Provider/Pharmacy search tool. You can also download or print a copy of the Pharmacy Directory. If you need help, please Contact Us.
Not all specialty pharmacies carry every drug. What they offer depends on the drug and your plan. Before you transfer or fill a new prescription, call the specialty pharmacy you choose to confirm they can fill your prescription.
For more information on our specialty pharmacies, please refer to your Evidence of Coverage or Contact Us.
Farmacias Fuera de la Red
We have thousands of pharmacies in our nationwide network to make it easy to get your prescription drugs. Using a network pharmacy is usually the best option to lower costs and reduce paperwork.
However, we know there may be times when you can't use a network pharmacy. We may cover your prescription filled at an out-of-network pharmacy if:
- No hay una farmacia de la red que esté cerca suyo y abierta, o
- Necesita un medicamento que no puede obtener en una farmacia de la red cercana a usted, o
- Necesita un medicamento para atención médica urgente o de emergencia, o
- Debe abandonar su hogar debido a un desastre federal u otra emergencia de salud pública.
Always Contact Us first or use the Find a Provider/Pharmacy tool to check if there is a network pharmacy near you.
Traveling or Away from Home
If you take a prescription drug on a regular basis and are planning to travel, be sure to check your supply before you leave. When possible, bring all the medications you will need for your trip. If you travel within the United States and territories, we may cover your drug at an out-of-network pharmacy for the same reasons as noted above. However, we cannot pay for any prescriptions filled outside of the United States and its territories, including prescriptions filled while traveling on cruises, even for a medical emergency.
If you use an out of network pharmacy, you may need to pay the full cost of your prescription at the time of purchase. You can then ask us to pay you back for our share of the cost. Approval is not guaranteed.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please Contact Us or refer to your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Reembolso de Recetas
Si necesita solicitar el reembolso de recetas que pagó de su bolsillo:
- Complete el Formulario de Reclamos por Medicamentos con Receta en el siguiente enlace.
- Si desea que otra persona complete este formulario en su nombre, incluya el Form CMS-1696: Formulario de Designación de Representante (AOR) con su Formulario de Reclamos por Medicamentos con Receta. Este formulario se encuentra en el enlace que aparece a continuación y también se puede encontrar en el sitio web de los Centros de Servicios de Medicare y Medicaid (CMS).
- Agregue la información de la etiqueta de la receta al formulario e incluya un comprobante de recibo de pago con cada formulario de reclamo que envíe. Si no tiene el recibo o la información necesaria para completar el formulario, puede solicitar ayuda en su farmacia.
- Envíe por correo el formulario completo y el recibo a la dirección que figura en el formulario. Debe presentar su reclamo dentro de los tres años siguientes a la fecha en que recibió su medicamento.
- También es una buena idea hacer una copia de los formularios y recibos para llevar un registro.
- Formulario de Reclamos por Medicamentos con Receta: inglés (PDF)
- Formulario de Reclamos por Medicamentos con Receta: español (PDF)
- Provider and Pharmacy Directory List
- Form CMS 1696: Formulario de Designación de Representante: inglés (PDF)
- Form CMS 1696: Formulario de Designación de Representante: español (PDF)
Después de recibir su solicitud, le enviaremos por correo nuestra decisión (determinación de cobertura) con un cheque de reembolso (si corresponde) dentro de 14 días.
Para obtener información específica sobre la cobertura de medicamentos, consulte su Evidencia de Cobertura o Comuníquese con Nosotros. Estamos aquí para ayudarlo.
Servicio de Envíos por Correo
You can fill your prescription at any network pharmacy. You can also fill your prescription through our preferred mail order service Express Scripts. This can save you time, money, and trips to the pharmacy.
Find more information about receiving your prescriptions through mail service delivery on the Mail Order Service page.
For additional information about in-network drug coverage, using an out-of-network pharmacy, specialty pharmacy, mail order service, prescription claims, or using our Find a Provider/Pharmacy tool, please refer to your Evidence of Coverage or Contact Us. We are here to help.
