Dean Advantage plans has approximately 60,000 participating pharmacies available for your use nationwide. Generally, we only cover drugs filled at an out-of-network pharmacy when a network pharmacy is not available. Before you fill your prescription in these situations, call Customer Service to see if there is a network pharmacy in your area where you can fill your prescription. Below are some circumstances when we would cover prescriptions filled at an out-of-network pharmacy:
- Coverage for out-of-network access of emergency drugs and some routine drugs will be provided when you cannot access a network pharmacy and one of the following conditions exists: You are traveling outside the service area and run out or become ill and need a covered drug.
- You are unable to obtain a particular drug as it is not regularly stocked at an accessible network pharmacy or mail order pharmacy (e.g. orphan or specialty drug with limited distribution).
- The network mail-order pharmacy is unable to get the covered drug to you in a timely manner and you run out of your drug.
- Drug is dispensed to you by an out-of-network institution based pharmacy while you are in an emergency department, provider-based clinic, outpatient surgery or other outpatient settings.
If you do go to an out-of-network pharmacy for the reasons listed above, you may have to pay the full cost (rather than paying just your copayment) when you fill your prescription. You can ask us to reimburse you for our share of the cost. Send us your request for payment along with your documentation of any payment you have made. You may pay more for a drug purchased at an out-of-network pharmacy because the out-of-network pharmacy's price is higher than what a network pharmacy would have charged. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy as any amount you pay, consistent with the circumstances listed above, will count toward any required deductibles.