Out-of-Network Coverage

We have an extensive national network of pharmacies where you can get prescriptions filled even when you’re away from home. Generally, you must use our network pharmacies, but under special circumstances we will cover prescriptions filled by an out-of-network pharmacy. In these cases, the supply you can purchase for a covered drug is limited to one month.

The special circumstances for using an out-of-network pharmacy are:

  • The prescription is for a medical emergency or urgent care.
  • You are unable to get a covered drug in a time of need because there are no 24-hour network pharmacies within a reasonable driving distance.
  • The prescription is for a drug that is out of stock at an accessible network retail pharmacy or CVS Caremark Mail Service Pharmacy (including high-cost and/or unique drugs).
  • If you are evacuated or otherwise displaced from your home because of a disaster or other public health emergency.
  • The drug is administered in your doctor’s office (must be Part D eligible).

Please note: If we do cover drugs you get at out-of-network pharmacies, you may still pay more than you would have paid at a network pharmacy.

How reimbursement works

If you use an out-of-network pharmacy for any of the reasons listed above, you will need to pay the full cost for your prescription at the time of purchase. That’s because the out-of-network pharmacies will not submit a claim to us. However, when you ask us to reimburse our portion of your cost, we will review your claim and notify you of our decision. If your claim is approved, we will send payment within 30 days of receiving your request.

How to submit a claim

Send us your request for payment, along with a receipt for your purchase. It’s a good idea to keep a copy of your receipts for your records. To make sure we have all the necessary information, we suggest that you complete and submit our claim form. You don’t have to use our form, but it will help us process the information faster.

Download a claim form (PDF) or Contact Us

Mail your payment request and any receipts to:
Blue MedicareRx (PDP)
Medicare Part D Paper Claims
P.O. Box 52066
Phoenix, AZ 85072-2066

You must submit your claim to us within three years of the date you filled the prescription.

Please contact Blue MedicareRx (PDP) for a printed version of our pharmacy directory or additional information.

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