Pharmacy Directory
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BR935272_MTS_WV_COVIN_061219.qxd 12/20/06 11:08 AM Page 1 Pharmacy Directory This booklet provides a list of Highmark Health Insurance Company’s FreedomBlue network pharmacies. This directory is for West Virginia All network pharmacies may not be listed in this directory. Please contact FreedomBlue at 1-800-590-2209, 24 hours a day, 7 days a week (except Thanksgiving and Christmas), for additional information. Pharmacies may have been added or removed from the list after this directory was printed. To get current information about FreedomBlue’s network pharmacies in your service area, please visit our website at www.highmark.com or call our Customer Service Department at 1-800-590-2209, 24 hours a day, 7 days a week (except Thanksgiving and Christmas). (TTY/TDD users should call 1-800-716-3231.) H5106_fbphd1006 CMS Approval 10/2006 BR935272_MTS_WV_COVIN_061219.qxd 12/20/06 11:08 AM Page 2 BR935272_MTS_WV_COVIN_061219.qxd 12/20/06 11:08 AM Page i INTRODUCTION This booklet provides a list of FreedomBlue’s network pharmacies and includes some basic information about how to fill your prescriptions with FreedomBlue. 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 FreedomBlue. In most cases, your prescriptions are covered under FreedomBlue 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. i BR935272_MTS_WV_COVIN_061219.qxd 12/20/06 11:08 AM Page ii Can the list of network pharmacies change? Yes, FreedomBlue may add or remove pharmacies from our pharmacy directory. To get current information about FreedomBlue’s network pharmacies in your area, please visit our website at www.highmark.com or call our Customer Service Department at 1-800-590-2209, 24 hours a day, 7 days a week (except Thanksgiving and Christmas). TTY/TDD users should call 1-800-716-3231. How do I find FreedomBlue’s network pharmacy in my area? To find a network pharmacy in this directory, follow these steps: 1. Locate the section for the type of pharmacy you are seeking (for example, “Retail Pharmacies”).You can find this information on the left or right edge of the page. 2. For retail, chain, and I/T/U pharmacies, locate the state, county, and city/town in which you would like to find a pharmacy. (Home infusion and long-term care pharmacies are located alphabetically within their respective sections.) 3. Once you have located your town or city, look through the alphabetical listing of pharmacies to find a pharmacy near you. Or you can visit our website at www.highmark.com or call our Customer Service Department at 1-800-590-2209, 24 hours a day, 7 days a week (except Thanksgiving and Christmas). TTY/TDD users should call 1-800-716-3231. How do I fill a prescription at a network pharmacy? To fill your prescription at a network pharmacy, you must show your FreedomBlue 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 Customer Service Department. How do I fill a prescription through FreedomBlue’s mail-order pharmacy service? To get order forms and information about filling your prescriptions by mail, please visit our website or call our Customer Service Department at 1-800-590-2209, 24 hours a day, 7 days a week (except Thanksgiving and Christmas). TTY/TDD users should call 1-800-716-3231. Please note that you must use the FreedomBlue mail-order service. Prescription drugs that you get through any other mail-order service are not covered. You can use the FreedomBlue mail-order service to fill prescriptions for most drugs on the formulary list. Mail order is most appropriate for drugs that you take on a regular basis for a chronic or long-term medical condition. Drugs that can not be purchased through mail order include ii medications with limited distribution and compound medications. It’s also more appropriate to use BR935272_MTS_WV_COVIN_061219.qxd 12/20/06 11:08 AM Page iii a retail network pharmacy for drugs used for a short period of time (1 month or less) and drugs needed immediately for the treatment of a severe medical condition. BY MAIL: 1. Ask your doctor to write a new prescription for up to a 90-day supply of medication, plus refills (as appropriate). 2. Choose a convenient payment method. You may pay by check, money order, or major credit card. If you prefer to pay by credit card, you may also want to join our automatic payment program by simply keeping your credit card information on file with us. 3. Mail the new prescription(s) in the return envelope provided with your Welcome Kit, along with a completed mail-order form and the appropriate payment. To obtain additional mail-order forms, or if you have questions, please call our Customer Service Department at 1-800-590-2209, 24 hours a day, 7 days a week (except Thanksgiving and Christmas). TTY/TDD users should call 1-800-716-3231. BY FAX: 1. Ask your doctor to write a new prescription for up to a 90-day supply of medication, plus refills (as appropriate). Give your doctor your Member ID number, which is on your Member ID card. 2. Ask your doctor to call the doctor prescription toll-free number at 1-888-327-9791, for directions on faxing your prescription to Medco. Please note that we only accept faxed prescriptions from your doctor. To ensure that you don’t run out of your medications, try to reorder at least 2 weeks before your prescription runs out. You can find your refill date on the prescription label and on the refill slip that comes with every order, or by visiting our website at www.medco.com. You can obtain refills in one of three ways: by mailing the order to us, by visiting our website, or by calling our Customer Service Department. 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. For more information, please look in the Evidence of Coverage or call our Customer Service Department for more information. It can take 5 days to receive your medication from the time you order. Make sure you have at least a 14-day supply of that medication on hand. If you don’t have enough, ask your doctor to give you a second prescription for a 30-day supply, and fill it at a retail network pharmacy while you wait for your mail-order supply to arrive. If your mail-order shipment is delayed, please call our Customer Service Department at 1-800-590-2209, 24 hours a day, 7 days a week (except Thanksgiving and Christmas). TTY/TDD users should call 1-800-716-3231. We’ll make sure you have your medication when you need it. iii BR935272_MTS_WV_COVIN_061219.qxd 12/20/06 11:08 AM Page iv Filling prescriptions outside the network Generally we only 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 Customer Service Department 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 above, will help you qualify for catastrophic coverage. To learn how to submit a paper claim, please refer to the paper claims process described later.