Medicare Matters. Amerihealth 65 for medicare Beneficiaries

AmeriHealth 65® Rx

Pharmacy network

Our plan contracts with FutureScripts® Secure to provide Medicare Part D prescription benefit management services and an extensive pharmacy network with more than 60,000 pharmacies.

The network includes:

  • national chain and independent retail pharmacies;
  • long-term care and home-infusion pharmacies;
  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Program pharmacies.

These pharmacies meet or exceed CMS (Centers for Medicare & Medicaid Services) requirements for pharmacy access in your area.

In order to receive benefits through the plan, prescriptions generally must be filled at a network pharmacy.

Find a network pharmacy

To locate or confirm that a pharmacy is currently in our network:

  • If you are already a member, call Member Services at the number printed on the back of your ID card, seven days a week, 8 a.m. to 8 p.m.
  • If you are not yet a member, call us at 1-800-898-3492 (TTY/TDD 1-888-219-5457), seven days a week, 8 a.m. to 8 p.m.

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).

You will need to pay the entire cost of the drug, and we will reimburse you the full amount minus the applicable cost-share.

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 for more information on paper claims or to request a form.

Mail-order pharmacy service

You can use our network mail-order pharmacy service to fill prescriptions for any drug on our formulary. Generally, it takes us ten to 14 days to process your order and ship it to you. You are not required to use our mail-order services to get an extended supply of mail-order drugs. You can also get an extended supply through some retail network pharmacies.

If you are a member and have questions, call Member Services at the number listed on the back of your ID card, 8 a.m. to 8 p.m., seven days a week.

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