ACCESS TO COVERED DRUGS AT NON-PLAN PHARMACIES
FILLING PRESCRIPTIONS RELATED TO A MEDICAL EMERGENCY
We will cover prescriptions that are filled at a non-plan pharmacy if the prescriptions are related to care for a medical emergency or urgently needed care. In this situation, you will have to pay the full cost (rather than just the 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 or receipt to our Client Services department.
COVERAGE WHEN YOU TRAVEL OR ARE AWAY FROM THE PLAN'S SERVICE AREA
If you take a prescription drug on a regular basis, and become ill, lose or run out of your prescription drugs while you are traveling within the United States, we will cover prescriptions that are filled at a non-plan pharmacy if you follow all other coverage rules. Prior to filling your prescription at a non-plan pharmacy, call our Client Services department to find out if there is a plan pharmacy in the area where you are traveling.
COVERAGE OUTSIDE OF THE UNITED STATES (INCLUDING CANADA)
Only drugs that are FDA approved and sold in the United States qualify for Part D benefit coverage. All drugs purchased outside the United States including Canada are excluded from Medicare Coverage.
OTHER TIMES YOU CAN GET YOUR PRESCRIPTION COVERED AT NON-PLAN PHARMACIES
We will cover your prescription at a non-plan pharmacy if at least one of the following applies:
• If you are unable to obtain a covered drug in a timely manner within our service area because there is no plan pharmacy within a reasonable driving distance that provides 24-hour service.
• If you are trying to fill a prescription for a covered drug that is not regularly stocked at an accessible plan retail or mail order pharmacy.
BEFORE YOU FILL YOUR PRESCRIPTION IN EITHER OF THESE SITUATIONS, CALL CLIENT SERVICES TO SEE IF THERE IS A PLAN PHARMACY IN YOUR AREA WHERE YOU CAN FILL YOUR PRESCRIPTION.
WHAT YOU MUST PAY FOR PRESCRIPTIONS FILLED AT NON-PLAN PHARMACIES
If you go to a non-plan pharmacy for any of the reasons listed above, 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 completed Pharmacy Reimbursement Form (requires Adobe Reader):(link away) Alliance Medicare PPO Form (need link)| HAP Senior Plus Form (need link)| Alliance Medicare Rx Form (need link) -- along with your receipt to:
HAP Pharmacy Services
ATTN: MA Reimbursement
2850 W. Grand Boulevard
Detroit, MI 48202
Upon receipt, we will make an initial coverage determination (need link) on the claim. To check on the status of a claim, or for more information, please call our Client Services department.