The pharmacies that contract with the plan are part of the network and may be called a network pharmacy or a participating pharmacy . Using a network pharmacy usually provides better benefits than using a non-network pharmacy. You may have a higher copayment at non-network pharmacies. If you use a non-network pharmacy, you may have to pay the pharmacy the entire price of the prescription first and then submit a claim to your plan for reimbursement. Most plans have a provider directory that lists the pharmacies in the network.
Plans generally furnish the provider directory when members sign up.
You can always call your plan s customer service representative to find out whether a particular pharmacy is a network pharmacy. My plan covers some drugs only if I obtain prior authorization before I fill the prescription. Some plans require that you or your child s doctor call to ask for coverage before you have certain drugs dispensed. This is often called prior authorization or precertification. Your plan contract outlines the drugs that require prior authorization and explains the procedure you must follow to obtain prior authorization.