Gemcare Medicare Plus Pharmacy Directory

Transcription

1 Gemcare Medicare Plus Pharmacy Directory This booklet provides a list of Gemcare Medicare Plus's network pharmacies. All network pharmacies may not be listed in this directory. Please contact Gemcare Medicare Plus at , 24 hours a day, seven days a week (TTY/TDD Users should call ) for additional information. Pharmacies may have been added or removed from the list after this directory was printed. To get current information about Gemcare Medicare Plus network pharmacies in your area, please visit our Website at or call our Customer Services Department at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) H5609_<material_id> <CMS approval date> 1

2 Introduction This booklet provides a list of Gemcare Medicare Plus's network pharmacies and includes some basic information about how to fill your prescriptions with Gemcare Medicare Plus. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage. We call the pharmacies on this list our network pharmacies because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Gemcare Medicare Plus. In most cases, your prescriptions are covered under Gemcare Medicare Plus only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one, you are not required to continue going to the same pharmacy to fill your prescription, you can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described later. Can the list of network pharmacies change? Yes, Gemcare Medicare Plus may add or remove pharmacies from our pharmacy directory. To get current information about Gemcare Medicare Plus network pharmacies in your area, please visit our Website at or call our Customer Services Department at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) How do I find Gemcare Medicare Plus network pharmacy in my area? You can visit our Website at or call our Customer Services at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) How do I fill a prescription at a network pharmacy? To fill your prescription at a network pharmacy, you must show your Gemcare Medicare Plus 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 (rather than paying just your co-payment). 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 Services. 2

3 How do I fill a prescription through Gemcare Medicare Plus's mail order pharmacy service? To get order forms and information about filling your prescriptions by mail, please contact Integrated Pharmacy Services at (TTY users should call ) Monday - Friday 8am - 6pm CST and Saturdays 8am - 12noon or via mail at PO Box 369 Boys Town, NE Please note that you must use the Gemcare Medicare Plus mail order service. Prescription drugs that you get through any other mail order service are not covered. You are not required to use mail order prescription drug services to obtain an extended supply of maintenance medications. Instead, you have the option of using a retail pharmacy in our network to obtain a supply of maintenance medications. Some retail pharmacies may agree to accept the mail order reimbursement rate for an extended supply of medications for up to 92 days per dispensing, which may result in no out-of-pocket payment difference to you. Please look in the Evidence of Coverage or call our Customer Services Department at and TTY/TDD for more information. The maximum expected turnaround time for the processing and shipment of all mail orders is five business days for orders that do not require a call to the prescriber or have a medication that is backordered. If for some reason your medication order from the mail order becomes delayed, you may always obtain a prescription from a local network pharmacy. 3

4 Filling prescriptions outside the network Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions fill at an out-of-network pharmacy. Before you fill your prescription in these situations, call our Customer Services Department, 24 hours a day, seven days a week at and TTY/TDD 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 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. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy as any amount you pay, consistent with the circumstance listed above, will help you qualify for catastrophic coverage. To learn how to submit a paper claim, please refer to the paper claims process described next. The following are a few exceptions when we will pay for a prescription filled at a pharmacy outside of our network. Getting coverage when you travel or are away from the plan s service area If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need. You may be able to order your prescription drugs ahead of time through our mail order pharmacy service. If you are traveling within the United States and territories and become ill, lose or run out of your prescription drugs we will cover prescriptions that are filled at an out-of-network pharmacy. In this situation, you will 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. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription. To learn how to submit a paper claim, please refer to the paper claims process described later. You can also call Customer Service to find out if there is a network pharmacy in the area where you are traveling. If there are no network pharmacies in that area, Customer Service may be able to make arrangements for you to get your prescriptions from an out-of-network pharmacy. We cannot pay for any prescriptions that are filled by pharmacies outside of the United States 4

5 and territories, even for a medical emergency. What if I need a prescription because of a medical emergency or because I needed urgent care? We will cover prescriptions that are filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgent care. In this situation, you will 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 paper claim form. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription. To learn how to submit a paper claim, please refer to the paper claims process described later. Other times you can get your prescription covered if you go to an out-of network pharmacy We will cover your prescription at an out-of-network pharmacy if at least one of the following applies: If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 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). If you are getting a vaccine that is medically necessary but not covered by Medicare Part B and some covered drugs that are administered in your doctor's office. 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 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 your claim and your receipt to the following address: Medicare Part D Paper Claims P.O. Box 407 Boys Town, NE 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. 5

6 For more information For more detailed information about your Gemcare Medicare Plus prescription drug coverage, please review the Evidence of Coverage and Gemcare Medicare Plus's formulary. If you have questions about Gemcare Medicare Plus, please call our Customer Services Department at , 24 hours a day, seven days a week. TTY/TDD Users should call Or, visit 6

7 Retail Pharmacies STATE: CA COUNTY: KERN CITY: Arvin ZIP: Bear Mountain Drug 505 Bear Mountain Blvd Arvin, CA CITY: Bakersfield ZIP: Bakersfield Homecare Pharmacy 2901 H St Emanuel Dozier, Md th St Greggs Pharmacy th St Lee's Clinical Pharmacy th St, Ste B Lee's Mercy Plaza Pharmacy th St Ste Med Mart Pps Pharmacy 2929 F Street Medical Pharmacy th St Mercy Plaza Pharmacy 24th Street 2336 Eye St Right Healthcare Pharmacy 1121 W Columbus St Rite Aid Pharmacy # rd St Sze K Ho Md 4040 San Dimas Ste A Walgreens Pharmacy # Chester Ave ZIP: El Tejon Drug 2900 Brundage Lane Bakersfield, CA Ming & H Drugs 1717 Ming Ave Bakersfield, CA Rite Aid Pharmacy # S H St Bakersfield, CA Sav-On Pharmacy # Brundage Lane Bakersfield, CA Wal-Mart Pharmacy # White Ln Bakersfield, CA Walgreens Pharmacy # S H St Bakersfield, CA Wible Pharmacy 2400 Wible Suite 1 Bakersfield, CA

8 ZIP: Lee's Niles Drug Store United Drugs # Niles St Bakersfield, CA Rufeners Alta Vista Drug 260 Bernard St Bakersfield, CA Silver Spray Pharmacy 2191 Niles St Bakersfield, CA ZIP: Longs Drug # Niles St Bakersfield, CA Longs Drug # Mount Vernon Ave Bakersfield, CA Rite Aid Pharmacy # Oswell St Bakersfield, CA Wal-Mart Pharmacy # Fashion Pl Bakersfield, CA Walgreens 24 Hr Pharmacy # Mount Vernon Ave Bakersfield, CA Walgreens Pharmacy # Niles St Bakersfield, CA Your Drug Store 2303 Niles Pt Bakersfield, CA ZIP: Ideal Pharmacy Services 9905 S Union Ave Bakersfield, CA Walgreens Pharmacy # Panama Ln Bakersfield, CA ZIP: Costco Pharmacy # Rosedale Hwy El Tejon Drug 2819 N. Chester Longs Drug # Coffee Rd North Chester 1822 N Chester Ave Oildale Community Health Center Pharmacy 525 Roberts Lane Rite Aid # Coffee Rd Rite Aid Pharmacy # China Grade Loop Rite Aid Pharmacy # Airport Dr Sav-On Pharmacy # Coffee Rd

9 ZIP: Comprehensive Blood & Cancer Center 6501 Truxton Ave Lees Bfmc Pharmacy 4570 California Ave Longs Drug # California Ave Longs Drug # Stine Rd Longs Drug # Stockdale Hwy Rite Aid Pharmacy # White Ln Truxton Pharmacy 5925 Truxton Ave Walgreens # Ming Ave Walgreens Pharmacy # White Ln ZIP: Hina's Mercy Southwest Pharmacy 500 Old River Rd Ste 12 Bakersfield, CA Hinas Homecare Pharmacy 9508 Stockdale Hwy #130 Bakersfield, CA Longs Drug # G Stockdale Hwy Bakersfield, CA Rite Aid Pharmacy # A Ming Avenue Bakersfield, CA ZIP: Faast Pharmacy 3400 Calloway Dr Bakersfield, CA Rite Aid Pharmacy # Allen Rd Bakersfield, CA Rite Aid Pharmacy # Calloway Dr Bakersfield, CA Sav-On Pharmacy # Rosedale Hwy Bakersfield, CA Save Mart Pharmacy # Hageman Rd Bakersfield, CA Wal-Mart Pharmacy # Rosedale Hwy Bakersfield, CA Walgreens Pharmacy # Hageman Bakersfield, CA

10 ZIP: Albertson's Pharmacy # Panama Ln Bakersfield, CA Costco Pharmacy # Panama Lane Bakersfield, CA Rite Aid Pharmacy # Panama Ln Bakersfield, CA Wal-Mart Pharmacy # Gosford Rd Bakersfield, CA Walgreens Pharmacy # Gosford Rd Bakersfield, CA CITY: Bakersfiled ZIP: The Community Pharmacy # th St Suite 302 Bakersfiled, CA CITY: California City ZIP: California City Pharmacy 8209 California City Bv California City, CA Rite Aid Pharmacy # California City Bl California City, CA CITY: Delano ZIP: Cole's Medical Arts Pharmacy 1205 Garces Hwy Delano, CA Delano Pharmacy th St Delano, CA Kmart Pharmacy # County Line Rd Delano, CA Komoto Pharmacy 1017 Ellington St Delano, CA Rite Aid Pharmacy # Cecil Ave Delano, CA CITY: Frazier Park ZIP: Frazier Park Pharmacy PO Box 250 Frazier Park, CA CITY: Kernville ZIP: The Drug Store 111 Piute Dr Kernville, CA CITY: Lake Isabella ZIP: Mesa Clinical Pharmacy PO Box 1628 Lake Isabella, CA Rite Aid Pharmacy #5797 PO Box 3740 Lake Isabella, CA CITY: Lamont ZIP: Medicine Shoppe # Main St Ste B Lamont, CA CITY: Mc Farland ZIP: Kern Avenue Pharmacy 143 W Kern Ave Mc Farland, CA CITY: Mojave ZIP: Mojave Pharmacy Hwy 14` Mojave, CA

11 CITY: Ridgecrest ZIP: Center Professional Pharmacy 1109 N China Lake Blvd Ridgecrest, CA Rite Aid Pharmacy # N China Lake Blvd Ridgecrest, CA Sav-On Drugs # S China Lake Blvd Ridgecrest, CA Wal-Mart Pharmacy # S China Lake Blvd Ridgecrest, CA Walgreens Pharmacy # Drummond Ave Ridgecrest, CA CITY: Rosamond ZIP: Antelope Vally Pharmacy 1431 Rosamond Blvd Rosamond, CA Rite Aid Pharmacy # W Rosamond Blvd Rosamond, CA Rosamond Pharmacy 1415 Rosamond Blvd #22 Rosamond, CA CITY: Shafter ZIP: Rite Aid Pharmacy # Central Avenue Shafter, CA Shafter Community Health Center Pharmacy 655 S Central Valley Hwy Shafter, CA Shafter Medical Pharmacy 825 S Central Valley Hwy Shafter, CA CITY: Taft ZIP: Kern Street Pharmacy 530 Kern St, Ste D Taft, CA Kmart Pharmacy # Gardner Field Rd Taft, CA Rite Aid Pharmacy # Kern St Taft, CA CITY: Tehachapi ZIP: Albertson's Pharmacy # Tucker Rd Tehachapi, CA Kmart Pharmacy # W Tehachapi Blvd Tehachapi, CA Rite Aid Pharmacy # Tucker Rd Tehachapi, CA Tehachapi Pharmacy 840 Tucker Rd Tehachapi, CA Walgreens # W Tehachapi Blvd Tehachapi, CA CITY: Wasco 11

12 ZIP: Kmart Pharmacy # Hwy 46 Wasco, CA Rite Aid Pharmacy # Highway 46 Wasco, CA Wasco Medical Center Pharmacy th St Wasco, CA Sav-On Drugs # W Avenue J Lancaster, CA Wal-Mart Pharmacy # Valley Central Wa Lancaster, CA Walgreens # W Ave L Lancaster, CA Wasco Valley Pharmacy 638 F Street Wasco, CA COUNTY: LOS ANGELES CITY: Lancaster ZIP: CVS Pharmacy # W Avenue L Lancaster, CA Quartz Hill Pharmacy th St W Ste 101 Lancaster, CA Sav-On Drugs # W Avenue L Lancaster, CA

13 Mail Order Pharmacy Integrated Pharmacy Services Home Infusion Pharmacies Are home infusion pharmacies part of Gemcare Medicare Plus's pharmacy network? Gemcare Medicare Plus will cover home infusion therapy if: l Your prescription drug is on Gemcare Medicare Plus's formulary or you have a formulary exception; l Gemcare Medicare Plus has approved your prescription drug for home infusion therapy; and l Your prescription is written by an authorized prescriber. STATE: CA COUNTY: KERN CITY: Bakersfield ZIP: Option Care Home Iv 1315 Boughton Dr

14 Long-Term Care Pharmacies Are long-term care pharmacies part of Gemcare Medicare Plus's pharmacy network? In some cases, residents of a long-term care facility may access their prescription drugs through the facility s long-term care pharmacy or another network long-term care pharmacy. STATE: CA COUNTY: KERN CITY: Bakersfield ZIP: Lee's Mercy Plaza Pharmacy th St Ste ZIP: Delano Reg Medical Ctr Phcy 1401 Garces Hwy Delano, CA Mercy Plaza Pharmacy 24th Street 2336 Eye St ZIP: Option Care Home Iv 1315 Boughton Dr ZIP: Ncs Healthcare Of Bakersfield 4300 Stine Rd Ste 700 Bakersfield, CA CITY: Delano 14

15 Network Pharmacies outside the geographic area We have network pharmacies outside of the service area where you can get your drugs covered as a member of our plan. Please call our call our Customer Services at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) for more information. 15