Frequently Asked Questions
How do I fill a prescription through Plan’s network mail order pharmacy service?
How do I fill a prescription outside the network?
How Do I Submit A Paper Claim?
CAN THE FORMULARY CHANGE?
If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
To get updated information about the drugs covered by Arcadian Health Plan, call Member Service at 1-800-573-8597, Monday through Sunday, 8:00 A.M. – 8:00 A.M. Mountain. TTY/TDD users should call 1-866-573-8591.
How do I fill a prescription through Plan’s network mail order pharmacy service?
You can use our network mail order pharmacy service to fill prescriptions for what we call “maintenance drugs.” These are drugs that you take on a regular basis, for a chronic or long-term medical conditions. These are the only drugs available through our mail order service. When you order prescription drugs through our network mail order pharmacy service, you must order 90-day supply of the drug. Generally, it takes us 14 days to process your order and ship it to you. However, sometimes your mail order may be delayed. If your prescription is delayed, contact your doctor to obtain a prescription for immediate use. Have the short-term prescription filled at a retail pharmacy in the network. You are not required to use our mail order services to get an extended supply of maintenance medications. You can also get an extended supply through some retail network pharmacies.
How do I fill a prescription outside the network?
We have network pharmacies outside of the service area where you can get your drugs covered as a member of our plan. Generally, we only cover drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions filled at an out-of-network pharmacy. Before you fill your prescription in these situations, call Member Service 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 for the reasons listed below, 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. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy as any amount you pay will help you qualify for catastrophic coverage (please refer to the Catastrophic Coverage section under Outpatient Prescription Drugs in the Summary of Benefits). If we do pay for the drugs you get at an out-of-network pharmacy, you may still pay more for your drugs than what you would have paid if you went to an in-network pharmacy.
How Do I 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, 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:
Caremark Claims Department
P.O. Box 686005
San Antonio, Texas 78268-6005
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