Getting Your Prescriptions Filled
What to Know Before You Go To The Pharmacy
Your plan covers Part D prescription drugs when they are filled at an in-network pharmacy or mail-order service. Most members pay reduced or $0 cost-sharing through Extra Help (Low-Income Subsidy). If you use a pharmacy outside the network without an approved exception, you will generally pay the full cost out of pocket.
Where to Fill Your Prescriptions
Choose from more than 3,000 pharmacies in the Elderplan network.
Network pharmacies that have a contract with Elderplan. When you fill a covered prescription at a network pharmacy, you pay only the amount you are responsible for under your plan.
Through CVS Caremark, you can get up to a 90-day supply of maintenance drugs delivered to your door.
Best for medications you take regularly for a chronic or long-term condition. Most orders arrive within 5–7 business days.
When Out-of-Network Coverage Applies
No 24-Hour Pharmacy in Your Area
If you can’t fill a covered prescription because there isn’t a 24-hour network pharmacy nearby, your plan may cover it at an out-of-network pharmacy
If Your Medication is Not Available
If you need a covered specialty medication, like an orphan drug or one shipped directly from the manufacturer—and it’s not available at a nearby network or mail-order pharmacy- your plan may still cover it
If You Use an Out-of-Network Pharmacy
You will generally pay the full cost when you fill your prescription. You can then request reimbursement from Elderplan for our share of the cost. You may also be required to pay the difference between what you paid and what the plan would have covered at a network pharmacy.
important reminders
About Your Pharmacy Benefit
Always show your Elderplan Member ID card.
Every time you get your prescriptions filled.
Your cost depends on your level of Extra Help
Members with Extra Help pay less for prescriptions. Your LIS rider shows the specific amounts that apply to your coverage.
Save money with mail-order
For medications you take regularly, get a 90-day supply by mail order or from a retail pharmacy if your network offers extended supplies.
Some prescriptions require approval
Some medications may require prior authorization or step therapy, or may have quantity limits. Learn more about Getting Approval for Medications.