Out-of-Network Coverage

Usually, we only cover drugs obtained from an out-of-network pharmacy in limited circumstances, when network pharmacies are not available. You can refer to Section 5 of your Evidence of Coverage to

learn more about the circumstances when we would cover prescriptions filled at an out-of-network pharmacies; or call our Member Services Department at 787-625-2126 (Metro Area), 1-866-516-7700 (toll free), or 1-866-516-7701 TTY (hearing impaired).

Please note that if you do go to an out-of-network pharmacy, you may have to pay the full cost (rather than paying just your copay) 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.