Pharmacy Information

What is a network pharmacy?

A network pharmacy is a pharmacy where you can get your outpatient prescription drug through your prescription drug coverage with SelectCare. These network pharmacies contract with SelectCare. In most cases your prescriptions are covered only if they are filled at one of our network pharmacies. You may choose any of SelectCare's network pharmacies. If and when you go to one pharmacy, you are not required to continue to go to the same pharmacy; you may choose to go to different network pharmacies.

How do you fill a prescription at a network pharmacy?

In order to fill a prescription at a network pharmacy, you must show your SelectCare membership card at one of our network pharmacies. If you do not have your membership card with you at the time you want a prescription filled, you might have to pay the full price for the medication rather than just your co-payment. If this happens, you may ask us to reimburse you by submitting a paper claim. See below to learn more about how to submit a paper claim.

How do you find a listing of the network pharmacies?

As a SelectCare member you will get a Pharmacy Directory, which gives you a list of our plan network pharmacies. This directory can assist you in finding a network pharmacy closest to you. If you don't have a pharmacy directory, you can request a copy by calling the member services department at SelectCare. The Member Service staff can also give you the most current information about changes in SelectCare's network of pharmacies. A copy of our pharmacy directory is available for download.

What if a pharmacy is no longer a "network pharmacy"?

In case a pharmacy might leave the plan's network, you will have to get your prescriptions filled at another network pharmacy. Please call SelectCare's member services department or refer to your Pharmacy Directory to find another network pharmacy in your area.

What if you fill a prescription outside the network?

SelectCare has network pharmacies outside of the service area where you can get your prescriptions covered as a member of our health plan. In general prescriptions filled at an out-of-network pharmacy may be covered under limited circumstances. Before you decide to fill a prescription at an out-of-network pharmacy please call the member servicesdepartment at SelectCare.

Listed below are some of the circumstances in which SelectCare would cover an out-of-network prescription:

Prescription filled at an out-of-network pharmacy that is related to a medical emergency or urgently needed care. In such situations you might have to pay the full cost of the medication, and submit a paper claim (143k PDF, 2pp.) to us in order to get reimbursed for the portion of the prescription the plan would have paid for.
If you are traveling within the United States, but outside of the Plan's service area, and you become ill, lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy if all other coverage rules are followed. In this case you might have to pay the full cost (rather than just paying your co-payment) when you have your prescription filled. Prior to filling a prescription at an out-of-network pharmacy, call the Member Services Department at SelectCare to find out if there is a network pharmacy in the area.
SelectCare cannot pay for any prescriptions filled by pharmacies outside of the United States even cases of a medical emergency.

What are some other instances you can get your prescriptions covered if you go to an out-of-network pharmacy?

SelectCare will cover your prescription at an out-of-network pharmacy if any of the following conditions are met:

In cases where you are unable to get a prescription filled in a timely manner at a network pharmacy because there is no network pharmacy that provides 24 hours service in your area.
If the covered prescription is not regularly stocked at the eligible network pharmacy in your area.

How do you submit a paper claim?

When you fill your prescriptions at one of our network pharmacies, that pharmacy submits the claim automatically. However, 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 automatically. If and when that happens, you may have to pay full price for your prescriptions. You should fill out the paper claim (143k PDF, 2pp.) form and submit the receipts to us at the following address:

SelectCare/PerformRx-Medicare Part D Claims
PO Box 516
Essington, PA 19029

Specialty Pharmacies

Home Infusion Pharmacies

SelectCare will cover home infusion therapy if:

Your prescription drug in on the plan's formulary,
Your prescription is written by a doctor,
All required coverage rules have been followed and SelectCare has approved your prescription for home infusion therapy,
You get your home infusion services from a network pharmacy in the Plan.

Long-term Care pharmacies

If you are residing in a long-term care facility, you may get your prescription medications through a long-term care pharmacy in the Plan's network of long-term care pharmacies. The pharmacy in some cases may contract directly with the long-term care facility. If it is not, or for more information, you contact SelectCare's Member Service's Department.