Out of Network Coverage

Managed Health Services (MHS) has a network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:
  • Emergency situations
  • When you are out of the service area for up to but no more than 6 months
 
We recommend that you fill all prescriptions prior to traveling out of the area so that you have an adequate supply. If you need assistance with obtaining an adequate supply prior to your departure, please contact Member Services You may pay more for any drugs you get at an out-of-network pharmacy than what you would have paid if you had gone to an in-network pharmacy. Reimbursement for out-of-network pharmacy claims will be made at our contracted rates. The difference will be your responsibility In these situations, please check first with Member Services at (888) 713-6180/TTY (800) 466-6136 from 8:00 a.m. to 8:00 p.m., 7 days a week, to see if there is a network pharmacy nearby. How do you ask for reimbursement from the plan? If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than paying your normal share of the cost) when you fill your prescription. You can ask us to reimburse you for our share of the cost.
 

Medicare Advantage