Pharmacy FAQs

Here are few things to keep in mind before you fill a prescription drug.

• Use a pharmacy that is in your plan’s network and Preferred Generic drugs (when available) to lower your cost (see your cost now by using our Drug Pricing tool). Using home delivery for ongoing maintenance medication may also save you money.
• Some drugs may require your doctor to submit a prior authorization before they’re covered (See drugs that may require Prior Authorization in our Medication Guide).
• Some drugs may be limited in the amount you can fill within thirty days, unless a special approval is obtained (see the Responsible Quantity Program in our Medication Guide).
• For plans that cover brand name drugs, certain brand name drugs may not be covered or will cost you more unless you have tried the generic alternative first (see the Responsible Steps Program in our Medication Guide).
• Many specialty drugs require a Prior Authorization and must be purchased from our Specialty Pharmacy network, to pay the lowest amount. Call Accredo at 1-888-425-5970 or Caremark at 1-866-278-5108 for more information (see more about Specialty Drugs in our Medication Guide).

IMPORTANT NOTE: Not all health plans come with pharmacy coverage and coverage varies by plan. If you’re part of an employer group, your employer may provide prescription drug benefits through another company. Please refer to your Benefit Booklet for coverage details, limitations and exclusions.

When you’re outside the state of Florida, take your prescription to a pharmacy that participates in our National Pharmacy Network. You can find National Participating pharmacies using our pharmacy website. If you don’t have your member ID card with you, you’ll have to pay for your prescription drug in full and then submit a claim form along with your receipt to the address shown on the form. If you go to a non-participating pharmacy, reimbursement will be based on our contracted rate (what we pay a participating pharmacy), less the amount of your applicable deductible and/or coinsurance. For help locating a National participating pharmacy, call the Customer Service number listed on your member ID card.

Simply complete the claim form, attach your receipt and send to the address indicated on the form.

You have two reimbursement options: 1) If you return to the pharmacy with your ID card within one week of your purchase, most pharmacies will rerun the prescription claim and reimburse the amount owed to you. 2) You can complete a Prescription Drug Program Claim form, attach your receipt(s) and send to the address shown on the form. Reimbursement will be based on our contracted rate (what we pay participating pharmacies), less the amount of your applicable copayment or deductible and/or coinsurance.

Our Medication Guide includes an abbreviated listing of brand name and generic prescription drugs that may be covered under your plan (i.e. covered drugs and requirements vary by plan). Please refer to your Benefit Booklet or Pharmacy Program Endorsement for complete coverage details. You can also look up drug information using our pharmacy website.

This flier gives details on where to get pharmacy and durable medical equipment (DME) supplies.