OXFORD MEDICARE ADVANTAGE® PHARMACY DIRECTORY This booklet provides a list of Oxford Medicare Advantage’s network pharmacies. All network pharmacies may not be listed in this directory. Please contact Oxford Medicare Advantage at 1-800-234-1228 (TDD: 1-800-201-4874), Monday through Friday from 8:00 AM to 6:00 PM for additional information. Pharmacies may have been added or removed from the list after this directory was printed. To get current information about Oxford Medicare Advantage network pharmacies in your area, please visit our web site at www.oxfordmedicare.com or call our Customer Service Department at 1-800-234-1228 (TTD: 1-800-201-4874), Monday through Friday from 8:00 AM to 6:00 PM. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance in Korean, 1-800-449-4390 para ayuda en espan˜ol, or 1-800-234-1228 for assistance in other languages MS-05-1190 CMS approved 09/05 TABLE OF CONTENTS INTROIDUCTION Can the list of network pharmacies change? . 1 How do I find an Oxford Medicare Advantage network pharmacy in my area? . 1 How do I fill a prescription at a network pharmacy? . 1 How do I fill a prescription through Oxford Medicare Advantage’s mail order pharmacy service? . 2 FILLING PRESCRIPTIONS AT A NON-NETWORK PHARMACY How do I get coverage when I travel or am away from the plan’s service area? . 2 What if I need a prescription because of a medical emergency or because I needed urgent care? . 3 How do I submit a paper claim? . 3 Where can I get more information? . 3 RETAIL PHARMACIES New York . 4 New Jersey . 62 Connecticut . 94 HOME INFUSION PHARMACIES Are home infusion pharmacies part of Oxford Medicare Advantages’s pharmacy network? . 99 LONG-TERM CARE PHARMACIES Are long-term care pharmacies part of Oxford Medicare Advantage’s pharmacy network? . 101 MAIL ORDER PHARMACIES For information about Mail Order Pharmacies . 105 INTRODUCTION This booklet provides a list of Oxford Medicare Advantage’s network pharmacies and includes some basic information about how to fill your prescriptions with Oxford Medicare Advantage. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan Members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Oxford Medicare Advantage. In most cases, your prescriptions are covered under Oxford Medicare Advantage only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one, you are not required to continue going to the same pharmacy to fill your prescription, you can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described later. Can the list of network pharmacies change? Yes, Oxford Medicare Advantage may add or remove pharmacies from our pharmacy directory. To get current information about Oxford Medicare Advantage network pharmacies in your area, please visit our web site at www.oxfordmedicare.com or call our Customer Services Department at 1-800-234-1228 (TTD: 1-800-201-4874), Monday through Friday from 8:00 AM to 6:00 AM. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance in Korean, 1-800-449-4390 para ayuda en espan˜ol, or 1-800-234-1228 for assistance in other languages. How do I find an Oxford Medicare Advantage network pharmacy in my area? This roster includes a list of select national network chains (with 25 or more stores) that participate with Walgreen’s Health Initiatives, Oxford Medicare Advantage’s pharmacy benefit manager. In addition, we have provided a detailed list of local, independent pharmacies that participate with Walgreen’s Health Initiatives. Or you can visit our web site at www.oxfordmedicare.com or by calling our Customer Service Department at 1-800-234-1228 (TTD: 1-800-201-4874), Monday through Friday from 8:00 AM to 6:00 PM. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance in Korean, 1-800-449-4390 para ayuda en espan˜ol, or 1-800-234-1228 for assistance in other languages. How do I fill a prescription at a network pharmacy? To fill your prescription at a network pharmacy, you must show your Oxford Medicare Advantage Member ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription (rather than paying just your copayment). If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Evidence of Coverage or call our Customer Service Department. 1 How do I fill a prescription through Oxford Medicare Advantage’s mail order pharmacy service? To get mail order forms and information about filling your prescriptions by mail, please call the Customer Service Department at 1-800-234-1228 (TDD 1-800-201-4874), Monday through Friday from 8 AM to 6 PM. Please note that you must use the Oxford Medicare Advantage mail order service. Prescription drugs that you get through any other mail order service are not covered. You can use the Oxford Medicare Advantage mail order service to fill prescriptions for any drug on the formulary list. When you order by mail, you must order a 90-day supply of the drug. You are not required to use mail order prescription drug services to obtain an extended supply of medications. Instead, you have the option of using a retail pharmacy in Oxford Medicare Advantage’s network to obtain a supply of medications. Some retail pharmacies may agree to accept the mail order reimbursement rate for an extended supply of medications, which may result in no out-of- pocket payment difference to you. Please look in the Evidence of Coverage or call our Customer Service Department at 1-800-234-1228 (TDD: 1-800-201-4874) for more information. Mail order requests will be shipped within fourteen days from the date the order is received. You should be sure to have a three-week supply of your medication on hand prior to sending your prescription order through the mail. This will allow enough time for your prescription order to be received and mailed to you without interfering with you dosage regimen. If you do not have a three-week supply, you should ask your physician for another prescription for a 30-day supply and bring it to a local Oxford Medicare Advantage network pharmacy. FILLING PRESCRIPTIONS AT A NON-NETWORK PHARMACY The following are a few exceptions when we will pay for a prescription filled at a pharmacy outside of our network. How do I get coverage when I travel or am away from the plan’s service area? If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need. You may be able to order your prescription drugs ahead of time through our mail order pharmacy service. If you are traveling within the United States and territories and become ill, lose, or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy. In this situation, you will have to pay the full cost (rather than paying just your copayment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription. To learn how to submit a paper claim, please refer to the paper claims process described later. You can also call Customer Service to find out if there is a network pharmacy in the area where you are traveling. If there are no network pharmacies in that area, Customer Service may be able to make arrangements for you to get your prescriptions from an out-of-network pharmacy. We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency. 2 What if I need a prescription because of a medical emergency or because I needed urgent care? We will cover prescriptions that are filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgent care. In this situation, you will have to pay the full cost (rather than paying just your copayment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription. To learn how to submit a paper claim, please refer to the paper claims process described later. Other times you can get your prescription covered if you go to an out-of network pharmacy.