FINAL FALL 2006 AMERIHEALTH NORTH PHARMACY 12.Sv
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A Medicare Advantage HMO Plan from AmeriHealth HMO, Inc. A Medicare Advantage HMO Plan from AmeriHealth HMO, Inc. AMERIHEALTH 65 AMERIHEALTH - NORTHERN NEW JERSEY COUNTIES – 2007 For more information... For updated information regarding participating pharmacies, visit our website at www.amerihealth65.com or call the Member Services Department at 1-800-645-3965 or TTY/TDD 1-888-857-4816. Representatives are available seven days a week, 8:00 a.m. to 8:00 p.m. Or call the Health Resource Center at 1-800-275-2583 or TTY/TDD 1-888-857-4816, Monday through Friday, 8:00 a.m. to 6:00 p.m. These resources offer additional details about participating pharmacies and help in finding a pharmacy to best fit your needs. AmeriHealth 65 2007 Pharmacy Directory 1901 Market Street • Philadelphia, PA • 19103-1480 www.amerihealth65.com Underwritten by QCC Insurance Company Place Union M0014_H3156_AH06_70 Bug Here 10957 9/06 (2006-0197) This booklet provides a list of AmeriHealth 65’s network pharmacies. This directory is for Bergen, Essex, Hudson, Hunterdon, Middlesex, Morris, Passaic, Somerset, Sussex, Union, and Warren Counties. All network pharmacies may not be listed in this directory. Please contact AmeriHealth 65 at 1-800-645-3965, seven days a week from 8 a.m. – 8 p.m. for additional information (TTY/TDD Users should call 1-888-857-4816). Pharmacies may have been added or removed from the list after this directory was printed. To get current information about AmeriHealth 65 network pharmacies in your area, please visit our Web site www.amerihealth65.com at or call our Member Services at 1-800-645-3965, seven days a week from 8 a.m. – 8 p.m. (TTY/TDD Users should call 1-888-857-4816). Introduction This booklet provides a list of AmeriHealth 65’s network pharmacies and includes some basic information about how to fill your prescriptions with AmeriHealth 65. 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 AmeriHealth 65. In most cases, your prescriptions are covered under AmeriHealth 65 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, AmeriHealth 65 may add or remove pharmacies from our pharmacy directory. To get current information about AmeriHealth 65 network pharmacies in your area, please visit our Web site at www.amerihealth65.com or call our Member Services at 1-800-645-3965, seven days a week from 8 a.m. – 8 p.m. (TTY/TDD Users should call 1-888-857-4816). How do I find an AmeriHealth 65 network pharmacy in my area? To find network pharmacies in your area please review the pharmacy listing in the directory. The pharmacies are listed in alphabetical order by state, county, city, and pharmacy name. Or, you can visit our Web site at www.amerihealth65.com or call our Member Services at 1-800-645-3965, seven days a week from 8 a.m. – 8 p.m. (TTY/TDD Users should call 1-888-857-4816). How do I fill a prescription at a network pharmacy? To fill your prescription at a network pharmacy, you must show your AmeriHealth 65 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 co-payment). 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 Member Services. How do I fill a prescription through AmeriHealth 65’s mail order pharmacy service? To get order forms and information about filling your prescriptions by mail, please contact Member Services by calling the number on the back of your identification card, or you can visit our website at www.amerihealth65.com. Please note that you must use the AmeriHealth 65 mail order service. Prescription drugs that you get through any other mail order service are not covered. You can use the AmeriHealth 65 mail order service to fill prescriptions for any drug on the formulary list. When you order prescription drugs by mail, you must order at least a 90-day supply, and no more than a 90-day supply of the drug. You are not required to use mail order prescription drug services to obtain an extended supply of maintenance medications. Instead, you have the option of using a retail pharmacy in our network to obtain a supply of maintenance medications. Some retail pharmacies may agree to accept the mail order reimbursement rate for an extended supply of medications for up to 90 days per dispensing, which may result in no out-of-pocket payment difference to you. Other retail pharmacies may not agree to accept the mail order reimbursement rate for an extended supply of medication. In this case, you will be responsible for the difference in price. Please look in the Evidence of Coverage or call Member Services for more information. Once you have mailed your prescription to Caremark Mail order, P.O. Box 94467, Palatine, IL 60094. Allow up to 14 days for the delivery of your medication. If your mail order has been delayed past the 14 days and you need to obtain a supply of your medication at a retail pharmacy in the AmeriHealth 65 network, please contact Caremark’s Member Services at 1-866-236-6714, Monday – Friday 6am-11pm, Saturday and Sunday 7am-11pm. Filling prescriptions outside the network Generally, we cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions filled at an out- of-network pharmacy. Before you fill your prescription in these situations, call Member Services to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an out-of- network pharmacy for the reasons listed below, you may have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. However, even after we reimburse you for our share of the cost, you may pay more for a drug purchased at an out-of- network pharmacy because the out-of-network pharmacy’s price is higher than what a network pharmacy would have charged. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy as any amount you pay, consistent with the circumstances listed below, will help you qualify for catastrophic coverage. To learn how to submit a paper claim, please refer to the paper claims process described next. The following are a few exceptions when we will pay for a prescription filled at a pharmacy outside of our network. Getting coverage when you travel or are 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 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 co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. To learn how to submit a paper claim, please refer to the paper claims process described later. You can also call Member Services 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, Member Services 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. 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 co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting paper claim form. To learn how to submit a paper claim, please refer to the paper claims process described later.