What is a network pharmacy?
A network pharmacy is one that we have made arrangements for them to provide prescription drugs to plan members. These pharmacies are where members can obtain prescription drug benefits provided by Samaritan Advantage Premier, Premier Plus, and Special Needs HMO Plans. Samaritan Health Plans has an arrangement with pharmacies all across the United States, which consists of approximately 90 percent of pharmacies. This equals or exceeds CMS requirements for pharmacy access in your area. In most cases, your prescriptions are covered if they are filled at a network pharmacy.
See Member Resources for the 2010 Pharmacy Directory
Once you go to a network pharmacy, you are not required to continue going to the same pharmacy to fill your prescription, you can go to any of our network pharmacies.
Out-of-network coverage
We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:
- If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24 hour service.
- If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail pharmacy (including high cost and unique drugs).
- If you are getting a vaccine that is medically necessary but not covered by Medicare Part B and some covered drugs that are administered in your doctor’s office.
Before you fill your prescription in any of these situations, call Customer Service 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 above, you will 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, visit Member Resources to download and print a Prescription Claim Form.
If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription.
Other Important Information regarding filling prescriptions:
Getting prescriptions when you travel
Mail order drugs
See Member Resources for the 2010 Formulary (List of Covered Drugs)
Last modified: March 11, 2010
H3811_MA4001 CMS approved 11.2009