Out of Network Coverage

Generally, Absolute Total Care pays for drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. We will pay for your prescriptions filled at an out-of-network pharmacy in the following cases:

  • When you are out of the area, require a prescription filled unexpectedly, and are unable to obtain medication at a network pharmacy.
  • During a declared disaster in your geographic area. If you cannot use a network pharmacy during a declared disaster, you will be able to fill your prescription drugs at an out-of-network pharmacy.

Generally, we only cover drugs filled at an out-of-network pharmacy in rare situations when a network pharmacy is not available, up to a 30-day supply.

You can use our Find a Doctor or Pharmacy Tool to help you locate a pharmacy that is in our network.

In these situations, please check first with Member Services at 1-855-735-4398. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

Will the plan pay you back for a prescription?

If you need an exception, a Member Services representative will work with you and your provider to help you ask for one.

Last Updated: 09/30/2017
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