Submit a Pharmacy Claim

If you choose to fill your prescription at a non-Participating Pharmacy, your costs may increase. You will likely need to pay for the entire amount of the prescription and then submit a prescription drug claim form for reimbursement to us.

Members that submit claims from non-Participating Pharmacies are reimbursed based on the lesser of the billed charge or on a prescription drug maximum allowed amount. The prescription drug maximum allowed amount may be considerably less than you paid for your medication. You are responsible for paying any difference in cost between the prescription drug maximum allowed amount and what you paid for your medication.

 

 

To submit a pharmacy claim, please download and fill out the Pharmacy Claim Form.

 

To submit a pharmacy compound claim, please download and fill out the Pharmacy Compound Claim Form.