We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:
- You are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service.
- You are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail-order pharmacy.
We will reimburse you for a prescription based upon the contracted rate that we would pay for the drug at a network pharmacy (not on the amount paid at an out-of-network pharmacy), less your plan cost-sharing. You will still be responsible for your share of the cost (your copay or coinsurance).
Note: Peoples Health Group Medicare (HMO-POS) and Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits plan members filling more than a 90-day supply of a prescription will be reimbursed based upon our contracted discount rate that we would pay for the drug at a network pharmacy and not on the amount paid at an out-of-network pharmacy. You will still be responsible for your share of the cost (your copay or coinsurance).
All other limitations, such as those on early refills or quantity limits that would have applied if the prescription was filled at a network pharmacy, apply at out-of-network pharmacies.