Generally, we only cover prescription medications filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Some circumstances when we would cover prescriptions filled at an out-of-network pharmacy are described below.
Before you fill your prescription in these situations, call Member Services to see if there is a network pharmacy in your area where you can fill your prescription. You can only fill up to a 30-day supply of medication at any out-of-network pharmacy.
If you do go to an out-of-network pharmacy for the reasons listed below, you may have to pay the full cost of the prescription (rather than just paying your copayment or coinsurance) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. However, even after we reimburse you for our share of the cost, you may pay more for a drug purchased at an out-of-network pharmacy because the out-of-network pharmacy's price is higher than a network pharmacy would have charged. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy as any amount you pay, consistent with the circumstances listed below, will help you qualify for catastrophic coverage. More information on filing a claim is available below.
Circumstances when we would cover prescriptions filled at an out-of-network pharmacy include:
If you are traveling within the United States and its territories and you become ill or lose or run out of your prescription drugs; and/or
If prescriptions are related to care for a medical emergency or urgent care.
If you fill a prescription at an out-of-network pharmacy under one of the circumstances described above, you should submit a claim to us.
When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, when you go to an out-of-network pharmacy, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription.
When you return home, simply submit your claim and your receipt to the following address:
HealthPartners Medicare Part D Pharmacy Claims
P.O. Box 64060
St. Paul, MN 55164
Upon receipt we will make an initial coverage determination on the claim. Please refer to your plan's Evidence of Coverage or call Member Services for more information on initial coverage determinations.
H2462 H9005 H9931_Web Site_229_092808. HealthPartners is a health plan with a Medicare contract.
