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.
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.
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)