Out of Network Coverage

Prescriptions that are included in the plan’s formulary must be obtained at a network pharmacy. However, there are certain situations in which you can obtain a covered drug in an Out-of-network pharmacy. Network pharmacies could include home infusion therapy, pharmacies in long-term care facilities and retail pharmacies that aren’t in the plan’s network. Circumstances in which you will be able to receive prescription coverage out-of-network includes:

• When you travel out of the plan’s service area.
• If you get sick and need a covered drug immediately and you do not have access to a network pharmacy.
• If you cannot obtain a covered drug in your service area in a timely manner due to lack of availability in a network pharmacy.
• If your covered drug is provided in an out-of-network pharmacy while you are in an emergency room, in a provider’s clinic, outpatient surgery, or in another facility.
• If you are given a shot covered by your plan at a doctor’s Office.
• If a covered prescription is not in inventory at an accessible in-network retail pharmacy.