Out of Network Coverage (Part D)

Trillium Medicare Advantage has a nationwide network of pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. However, we understand you may not always be able to use a network pharmacy. We may cover prescriptions filled at an out-of-network pharmacy if:

  • There is no network pharmacy that is close to you and open.
  • You need a drug that you can’t get at a network pharmacy close to you.
  • You need a drug for emergency or urgent medical care.
  • You must leave your home due to a federal disaster or other public health emergency.

Before you have your prescription filled in these situations, contact us to check if there is a network pharmacy in your area that can fill your prescription. If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than paying your normal share of the cost) when you fill your prescription. If this happens, please call Member Services and ask us to reimburse you for our share of the cost.

How do you ask for reimbursement from the plan?

  1. Print and fill out the Prescription Claim Form - HMO SNP Form
  2. Attach the original copy of your prescription receipts to the form.  If you do not have the original receipt, a copy can be obtained from the dispensing pharmacy.  Cash register receipts may not be used when submitting a claim form.
  3. Mail the completed form and receipts to the address listed on the form. 

Once we receive your claim, we will mail our determination with a reimbursement check (if applicable), within 14 days.  For specific information about drug coverage limitations, please refer to your Evidence of Coverage or call Member Services.  We are here to help!


Last Updated: 09/30/2017
H2174_18_3493WEB_Approved_09282017