Know your benefits

If you are on vacation and are in need of medication (because medicine was forgotten or you ran out), there are a number of options depending on where you are vacationing and what medicine(s) you need. Often, the best solution is to have a pharmacy near you contact the pharmacy where you normally fill prescriptions to transfer the prescription to refill there. If it is too soon to refill, in order to avoid running out of medicine, you can call our customer service number at 844.454.5201, and we can work with you to find a solution.

Filling and delivery of mail order prescriptions, both new and refilled prescriptions, are managed by the mail order pharmacy contracted with your insurance plan. For the most up-to-date status of a mail-order prescription or delivery, you can call the mail order pharmacy directly. If you have any trouble calling the mail order pharmacy, you can also call our customer service number and a member of our team can coordinate with the mail order pharmacy to help you with a status update.

Auto-fill (or auto-refill) is a convenient and time-saving option for most of your mail order prescriptions. Opting-in for auto-refill may allow you to maintain consistency in taking your medications. As such, it is a great option for chronic medicines that you take regularly and are important to take consistently. For medicines not on auto-refill, you would need to order each refill, requiring you to plan and call early to allow enough time before you run out of medicine. For prescriptions on auto-refill, instead of contacting the mail order pharmacy each time you need a refill, the medicine is automatically refilled and delivered to you according to your prescription schedule. To place a prescription on auto-refill, you will need to call your plan’s mail-order pharmacy to opt-in for each prescription that you would like on auto-refill. If at any time your doctor stops a medicine that was on auto-refill, please call the mail order pharmacy to let them know that you are no longer taking this medicine to avoid being charged and sent medicine you no longer need.

Quantity Limits specify a maximum dosage or quantity that will be covered (for example, a maximum number of tablets per day). These quantity limits often reflect safe and effective doses for a given medication. Any dosing (reflected in quantity per day) up to the quantity limit will be covered, but dosing quantities above the quantity limit will be initially rejected. In order for any prescription exceeding a formulary quantity limit to be covered, the prescribing doctor will need to apply for a prior authorization, providing medical justification for the higher dosing to be reviewed by our clinical team.

Sometimes you can’t use your pharmacy benefits when you’re at the pharmacy. If that happens, you can download the reimbursement form from your member portal account and submit it to us and we’ll help you get your money back. If you’re not registered, call our customer support team at 844.454.5201 and we can email the form to you and answer any questions about the process. Reimbursement for these prescriptions will be based on your benefit plan design.

Generic, Preferred Brand, and Non-Preferred Brand drugs refer to classifications of drugs that correspond to Tiers (Tier 1 through Tier 3) in your prescription benefits plan. Copay, in addition to other factors such as day supply of the prescription, is determined by the drug’s tier. Your prescription drug plan may designate certain brands as preferred (typically Tier 2) and some as non-preferred (Tier 3). Brand name drugs tend to be more expensive. Generic versions of those brand name drugs have the same active ingredients but tend to be less expensive. For example, Tylenol is a brand drug and acetaminophen is its generic equivalent.

Step Therapy is a condition in which certain drugs require other medications to be tried before they can be covered by insurance. Step Therapy may have one or more levels of criteria (steps) that must first be fulfilled. If your doctor prescribes, or wants to prescribe, a medication that requires step therapy, he/she can call 844.512.3030 to work with our clinical team to coordinate therapy and determine what is needed.