Filling prescriptions at an out-of-network pharmacy
Sometimes, you may have to go to a pharmacy that is not in our network. Before you go to one of these pharmacies, make sure that you know our rules.
Usually, you will have to pay the full cost of your prescription at an out-of-network pharmacy. Then, you can ask us to reimburse you for our share of the cost by submitting a claim form.
If you go to a pharmacy that is not in our network, you might have to pay more than your regular co-payment. Why? Well, when we created our pharmacy network for you, the pharmacies that joined us agreed to give you some prescription drugs at a lower price. If you go to a pharmacy that did not agree to a lower price, you will have to pay for the difference.
To avoid this problem, remember to call Member Services before you visit an out-of-network pharmacy. We may be able to find a pharmacy in your area that is in our network.
Getting a prescription when you travel
If you go on a trip, be sure to take all of the medicine that you will need.
If you go on a trip, Passport Advantage will cover your medicines from an out-of-network pharmacy only if:
- You become ill,
- You lose your medicines, or
- You run out of your medicines.
We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and its territories, even in an emergency.
Getting a prescription in a medical emergency
You can go to an out-of-network pharmacy if you need the medicine to care for a medical emergency or urgent care.
Getting a prescription in other situations at an out-of-network pharmacy
We will cover your prescription at an out-of-network pharmacy if:
- You cannot get a covered medicine in a timely manner in our service area because there is no network pharmacy within a reasonable driving distance that provides 24-hour service.
- You are trying to fill a prescription for a medicine that an accessible network pharmacy does not already have (including high cost and unique drugs).
Submitting a paper claim
When you go to a pharmacy that is in our network, the pharmacy automatically sends us a claim for your prescription. But, if you go to an out-of-network pharmacy, the pharmacy may not be able to send the claim directly to us. You will then have to pay the full cost of your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form.
Download a copy of a Claim Form
Send this completed claim form and the receipt for your prescription to:
Passport Advantage/Perform Rx - Medicare Claims
PO Box 516
Essington, PA 19029
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