Medicare Health Plans >> Out of Area Coverage

Medicare Health Plans

Filling Prescriptions Outside the Network

Generally, Welborn Health Plans 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 the Rx Customer Care number on the back of your ID card 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-ofnetwork 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-ofnetwork 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 next.

The CVS Caremark Part D Services, LLC pharmacy network has pharmacies in all 50 states. When traveling outside the service area, members should contact Rx Customer Care at 1-888-816-7981 (TDD/TTY 866-236-1069) to find the nearest participating pharmacy. In the unlikely event that a participating pharmacy is not within 30 miles of the member’s location, the member may use any pharmacy and submit their receipts to Welborn Health Plans for reimbursement. Pharmacies outside the United States or its overseas possessions may not be used. Only 30 days supply of medication or supplies may be dispensed by a nonparticipating pharmacy.

In the event of travel requiring more than 30 days outside the service area, the member should contact Customer Service at:

Welborn Health Plans Customer Services
101 S.E. 3rd Street
Evansville, IN 47708
(812) 426-6600
Toll Free: 1-800-521-0265
TTY users may call Indiana Relay: 1-800-743-3333
FAX: (716) 541-6311

 

H3044_H1558_WHPWeb (10/2009)