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.