Use a Network Pharmacy to Be Covered
All Part D plans must provide a network of retail pharmacies in your area that accept the plan.
You must use a network retail pharmacy or the mail order pharmacy to be covered for benefits, except in an emergency. When you fill a prescription for a covered drug at a network pharmacy, you pay only your coinsurance or copayment amount and your pharmacy automatically submits your claim to us.
NRECA has a national network of retail pharmacies, including its special rural pharmacy network and other pharmacies in addition to CVS pharmacies. This way, it is convenient for you to find a pharmacy wherever you are in the country. Use the Pharmacy Locator to find a participating network pharmacy in your area.
If You Use an Out-of-Network Pharmacy
There are extenuating circumstances for which you may be covered for benefits when you have a covered drug filled at an out-of-network pharmacy, such as home infusion therapy, long-term care facility pharmacies and retail pharmacies that are not in the plan’s network.
Before you fill your prescription at an out-of-network pharmacy, call Customer Care to see if there is a network pharmacy in the area where you can fill your prescription.
These extenuating circumstances include:
- when you are traveling outside of your plan’s service area
- if you lose or run out of your covered drugs or you become ill and need a covered drug immediately and cannot access a network pharmacy
- if you cannot obtain a covered drug within your service area in a timely manner due to lack of availability of a participating network pharmacy
- if your covered drug is provided by an out-of-network institution-based pharmacy while you are in an emergency department, provider-based clinic, outpatient surgery, or other outpatient setting
- if you are administered a vaccine covered by your plan in a physician’s office
- if you must fill a prescription for a covered drug and the drug is not regularly stocked at an accessible network retail or mail-order pharmacy.
Submit a paper claim for an out-of-network prescription
If you go to an out-of-network pharmacy for any of the reasons listed above, you will need to pay the full cost for your prescription and submit the claim yourself. Your pharmacy will not send the claim in this case.
You will need to submit a claim
- to be reimbursed for your out-of-pocket costs that would normally be covered
- so the plan has a record of your purchase and applies it to your annual deductible or true out-of-pocket cost (TrOOP).This helps you qualify for catastrophic coverage faster.
You must mail the completed paper claim form along with the pharmacy receipt that lists the name of your covered prescription drug (not the sales receipt) to:
NRECA's Part D Plan
c/o Caremark Pharmacy Service
Paper Claims Department
P.O. Box 52193
Scottsdale, AZ 85072-2193
We will review the claim form and make an initial coverage determination. Your claim will be processed according to your benefit coverage and you will be notified of the outcome. For more information about initial coverage determinations, limits and financial responsibilities, refer to your Summary Plan Description and Evidence of Coverage or call Customer Care.