Pharmacies

  • About out-of-network pharmacies

    We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. The circumstances when we would cover prescriptions filled at an out-of-network pharmacy are listed below. Before filling your prescription in these situations, call customer service to see if there is a network pharmacy in your area where you can fill your prescription.

    • You are outside the service area and run out of or lose your covered Part D drugs or become ill and need a covered Part D drug.
    • You are unable to obtain a covered drug in a timely manner at a network pharmacy in your service area (for example, no access to 24-hour, 7-day-a-week network pharmacy).
    • You are unable to obtain a particular drug as it is not regularly stocked at an accessible network pharmacy or mail order pharmacy (for example, orphan or specialty drug with limited distribution).
    • Network mail-order pharmacy is unable to get the covered Part D drug to you in a timely manner and you run out of your drug.
    • Drug is dispensed by an out-of-network, institution-based pharmacy while you are in an emergency department, provider-based clinic, outpatient surgery, or other outpatient setting.
    • During any federal disaster declaration or other public health emergency declaration in which you are evacuated or otherwise displaced from your place of residence and cannot be reasonably expected to obtain your covered Part D drugs at a network pharmacy.

    We will cover prescriptions that are filled at an out-of-network pharmacy for medical emergencies and in some routine situations for up to a one-month* supply. Drugs excluded by federal statute from the Medicare Part D formulary are not eligible for coverage even in emergency or urgent situations.

    What if my pharmacy leaves the network?

    If the pharmacy you have been using leaves the plan's network, you will have to find a new pharmacy that is in the network. If the pharmacy you have been using stays within the network but is no longer offering preferred cost-sharing, you may want to switch to a different pharmacy. To find another network pharmacy in your area, go to premera.com/ma and select Find a Pharmacy, or call customer service at 888-850-8526 (TTY/TDD: 711) Monday to Friday, 8 a.m. to 8 p.m., (or 7 days a week, 8 a.m. to 8 p.m., October 1 to March 31).

    *One month equals:
    30 days - HMO, Classic (HMO), Classic Plus (HMO) and Total Health (HMO)
    31 days - Peak + Rx (HMO), Sound + Rx (HMO) and Charter + Rx (HMO)