Managed care plans create pharmacy networks by contracting with specific pharmacies to serve the plan s members at more favorable prices for the managed care plan. 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.