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Pharmacy Network

PART D COVERAGE OUTSIDE OF THE SERVICE AREA

Simply Healthcare offers national in-network prescription drug coverage. This includes the 50 States and the District of Columbia.

This means that you will pay the same cost sharing amount for your prescription drugs if you get them at an in-network pharmacy outside the plan’s service area (for instance when you travel).

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.

If you are traveling within the U.S. and become ill, lose or run out of your prescription drugs, the plan will cover prescriptions that are filled at an out-of-network pharmacy if you follow all other coverage rules. Prior to filling your prescription at an out-of-network pharmacy, call the Member Services Department 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, the Member Services Department 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 the United States, even for a medical emergency.

OUT OF NETWORK PHARMACIES

In special circumstances, for instance, illness while traveling outside the plan’s service area where there is no network pharmacy, drugs listed on the plan's formulary may be covered. You may have to pay more than your normal cost sharing amount if you get your drugs at an out of network pharmacy. In addition, you will likely have to pay the full amount for the drug at the pharmacy and submit documentation to receive reimbursement from Simply Healthcare.

 

 Direct Member Reimbursement Form

 

 

 

Last Updated: 
October 1, 2018