Using an Out-of-Network Retail Pharmacy
When you fill a prescription at an Out-of-Network
retail pharmacy, you pay the full cost of the prescription
when you have it filled. You must obtain a detailed receipt
for each prescription drug that you purchase. Then you
must complete a claim form supplied by Caremark® or
MILA and send the claim form and each receipt from the
pharmacy to Caremark® for processing. The receipts must
include the following:
- The name and address of the dispensing pharmacy;
- The prescription number;
- The name of the drug;
- The quantity dispensed;
- The date the prescription was filled; and
- The cost of the prescription.
You can receive claim forms by calling the telephone
number on your ID card, through Caremark®’s website or
from MILA. Mail your claim form and pharmacy receipt to
Caremark® at the address shown on the form. Caremark®
will deduct the appropriate copay and then reimburse you
up to the amount the prescription would have cost at an
In-Network pharmacy. You are responsible for any
additional cost.
For example, let’s say a generic medication costs $20 at
an In-Network pharmacy and $38 at an Out-of-Network
pharmacy. As a MILA National Health Plan participant
(the Core Plan copay differs), you would pay only $5 at
the In-Network pharmacy and the Plan would pay $15. At
the Out-of-Network pharmacy, you would pay $38, then
file a claim along with the pharmacy receipt and wait for reimbursement.
The Plan would pay you $15, and you would
be responsible for $23 ($38 minus $15).
