Pharmacy Info
Local, National, and Mail Order Pharmacy
With CDPHP Medicare Choices Drug Plans, you'll have access to 4,728 pharmacies throughout New York state, and over 61,000 pharmacies across the country.
You can also choose to have your prescription filled and mailed directly to your home or office using the Caremark® mail order pharmacy service.
Prescriptions that are included in the Part D formulary must be filled at a network or "preferred" pharmacy in order to receive coverage. However, there may be extenuating circumstances for which you can obtain coverage for a formulary drug that is filled out-of-network.
Preferred Pharmacy
Preferred pharmacies are pharmacies in our network in which our Plan has negotiated lower cost sharing for its plan members for covered prescription drugs than at “non-preferred pharmacies.” However, you will still have access to lower drug prices at “non-preferred pharmacies” than at out-of-network pharmacies. You may go to either of these types of network pharmacies to receive your covered prescription drugs. Preferred pharmacies include all CVS locations nationwide and the Caremark® Mail Order Service.
Out-Of-Network Pharmacy
Out-of-network pharmacies are those pharmacies that are not in the plan's network. 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. 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.
- When you are traveling outside your plan’s service area.
- If you lose or run out of your covered drugs or you become ill and need a covered drug immediately and cannot access a network pharmacy.
- If you cannot obtain a covered drug within your service area in a timely manner due to lack of availability of a participating network pharmacy.
- If your covered drug is provided by an out-of-network institution-based pharmacy while you are in an emergency department, provider-based clinic, outpatient surgery, or other outpatient setting.
- If you are administered a vaccine covered by your plan in a physician’s office.
- If you must fill a covered drug prescription and the drug is not regularly stocked at accessible network retail or mail-order pharmacies.
How to submit a paper claim for an out-of-network prescription.
If you go to an out-of-network pharmacy for any 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 and mail the completed claim form along with the receipt to:
SilverScript, LLC
Medicare Part D Paper Claims
P.O. Box 52092
Phoenix, AZ 85072-2092
Upon receipt, an initial coverage determination will be made on the claim. For more information on initial coverage determinations, limits, and financial responsibilities, please refer to your Evidence of Coverage or call Customer Care.