Reimbursement Policy

The plan shall determine if a pharmacy reimbursement should be granted in response to the written request from a member or their authorized representative. Reimbursement involves the submission of a pharmacy receipt no older than 180 days (from the date it was denied by the plan) and the reimbursement form. The plan must process the request within the 72-hour timeframe established by CMS for a coverage determination and make payment within 30 calendar days after having received the request.

To learn how to submit a paper claim, please refer to the paper claims process described in Section 5 of your Evidence of Coverage.

You may also need to complete the following Reimbursement Form.