AmeriHealth 65 Basic contracts with PerformRx to provide Medicare Part D prescription benefit management services and an extensive pharmacy network.
The network includes:
- national chain and independent retail pharmacies,
- long term care and home infusion pharmacies
Perform Rx currently contracts with over16,000 pharmacy providers. This pharmacy count is current as of October 1, 2006.
AmeriHealth 65 Basic has contracts with pharmacies that equal or exceed CMS requirements for Pharmacy access in your area.
In order to receive benefits through AmeriHealth 65 Basic prescriptions must be filled at an AmeriHealth 65 Basic network pharmacy. However, covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside of the Plan's service area where there is no network pharmacy. You will need to pay the entire cost of the drug and then AmeriHealth 65 Basic will reimburse you the full amount minus the applicable copayments.
AmeriHealth 65 Basic Pharmacy Directory
In order to receive benefits through your prescription plan, prescriptions must be filled at a network pharmacy. To confirm that a pharmacy is in our network, please call the Member Services Department at 1-888-457-3018 (TTY/TDD 1-888-857-4816) 8:00 am to 8:00 pm seven days a week.
Out of Network Coverage
Covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside of the Plan's service area where there is no network pharmacy. We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:
- If the prescriptions are related to care for a medical emergency or urgent care.
- If you are unable to obtain 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.
- If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail order pharmacy (including high cost and unique drugs).
- Some covered drugs that are administered in your doctor's office.
We cannot pay for any prescriptions that are filled by pharmacies outside the United States, even for a medical emergency.
How to submit a paper claim
When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy for one of the reasons listed above, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription. When you return home, simply submit a claim form and your receipt.
Please call Member Services at 1-888-457-3018 (TTY/TDD 1-888-857-4816) 8:00 am to 8:00 pm seven days a week for more information on paper claims or to request a form.
