You are here

Non-Network Pharmacy Benefits

HealthChoice Medicare Supplement Plans Non-Network Pharmacy Benefits

HealthChoice covers your prescriptions when they are filled at a non-Network pharmacy subject to the following provisions.

SilverScript Plans

When you fill your prescriptions at a non-Network Pharmacy, a reduced benefit applies. In certain emergency situations, your prescriptions can be covered as if they were filled at a Network Pharmacy. An exception can be made if you cannot access a Network Pharmacy due to the following emergencies:

  • You travel outside the HealthChoice service area and lose or run out of medication or become ill and need a Part D medication;
  • You cannot fill a specialty drug timely because it is not in stock;
  • There is no Network Pharmacy within reasonable driving distance with 24/7 service;
  • You receive a Part D drug while in an emergency, observation or other outpatient setting; or
  • Evacuation or displacement from your residence due to a federal declared national disaster or other public health emergency.

You can replace medications that were lost or damaged due to a declared national disaster or public health emergency. Your pharmacy must contact the pharmacy helpline toll-free at 1-866-693-4620. The helpline staff will work with your pharmacy to provide early refills or override the maximum supply per fill. You must still pay the applicable copay per fill.

If you must use a non-Network Pharmacy, you must pay the full cost for your medications and then file a paper claim for HealthChoice to repay you for its share of the cost. Before you fill a prescription under these circumstances, check for a Network Pharmacy in your area by contacting the pharmacy benefit manager toll-free at 1-866-275-5253. TTY users call 711.

Without Part D Plans

When you fill your prescriptions at a non-Network pharmacy, a reduced benefit applies. When you use a non-network pharmacy, you pay the full amount and submit your claim to the pharmacy benefit manager for reimbursement.

Before you fill your prescriptions at a non-Network pharmacy, when possible, check to find out if there is a Network Pharmacy in your area by contacting the pharmacy benefit manager toll-free at 1-877-720-9375. TTY users call 711.