When can I get a prescription filled at a non-network pharmacy?

We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

  • The prescription is for a medical emergency or urgent care.
  • You are unable to get a covered drug in a time of need because there are no 24-hour network pharmacies within a reasonable driving distance.
  • The prescription is for a drug that is out of stock at an accessible network retail or mail service pharmacy (including high-cost and unique drugs).
  • You are limited to a 30-day (31-days for a long-term care) supply of drugs when filled at an out-of-network pharmacy.

If you fill a prescription at a non-network pharmacy, you will need to pay for the entire cost of the prescription and submit a prescription claim form for reimbursement.

Last updated: 01/01/2018

Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal.