PHARMACY SERVICES

Community Health Partnership, Inc. has agreements with a network of pharmacies. We call the pharmacies our “network pharmacies” because we have made arrangements with them to provide prescription drugs to our members. A network pharmacy is a pharmacy where members obtain prescription drug benefits provided by Community Health Partnership, Inc. In most cases, your prescriptions are covered under Community Health Partnership, Inc. only if they are filled at a network pharmacy. Under certain circumstances, we will fill prescriptions at non-network pharmacies.

Community Health Partnership, Inc. may add or remove pharmacies. To obtain current information about Community Health Partnership, Inc.’s network pharmacies in your area, see this website, or call our Customer Service Department at 1-800-546-5677, 24 hours a day, seven days a week. (TTY/TDD Users should call 1-866-706-4759.).

Filling a Prescription

To fill your prescription at a network pharmacy, you must show your Community Health Partnership, Inc. Member ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription. If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Evidence of Coverage or call our Customer Service Department.

Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Before you fill your prescription at an out-of-network pharmacy, call our Customer Services Department, 24 hours a day, seven days a week at 1-800-546-5677 and TTY/TDD 1-866-706-4759 to see if there is a network pharmacy in your area where you can fill your prescription.

If you do go to an out-of-network pharmacy you may have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. However, even after we reimburse you for our share of the cost, you may pay more for a drug purchased at an out-of-network pharmacy because the out-of-network pharmacy's price is higher than what a network pharmacy would have charged.

Submitting 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, 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 your claim and your receipt to the following address: Medicare Part D Paper Claims, 13660 California Street, Omaha, NE 68154. Upon receipt, we will make an initial coverage determination on the claim. Please refer to your Evidence of Coverage or call Customer Service for more information on initial coverage determinations.

For more detailed information about your Community Health Partnership, Inc. prescription drug coverage, please review the Evidence of Coverage and Community Health Partnership, Inc.’s formulary.

If you have questions about Community Health Partnership, Inc., please call our Customer Service Department at 1-800-842-1814 Monday through Friday 8:00 AM to 4:30 PM TTY/TDD users should call 1-715-838-2900.