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Questions and Answers about CareOregon Advantage Prescription Drug Coverage
Can the list of network pharmacies change?
Yes. CareOregon Advantage may add or remove pharmacies from our pharmacy directory. To get current information about our network pharmacies in your area, call Customer Service at 503-416-4100 in the Portland area or toll free at 800-224-4840, daily, 8 a.m. to 8 p.m. TTY/TDD users should call 1-877-416-4161.
How does CareOregon Advantage meet Medicare Part D access requirements?
CareOregon Advantage has contracts with pharmacies that equal or exceed Medicare requirements for pharmacy access in your area.
How do I fill a prescription at a network pharmacy?
To fill your prescription at a network pharmacy, show your CareOregon Advantage ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription (rather than paying just your co-payment). If this happens, you can ask us to reimburse you for our share of the cost by submitting a paper claim.
Can I fill a prescription at an out-of-network pharmacy?
With the following exceptions, you must use network pharmacies:
- If you are traveling within the United States and become ill, lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy. In this situation, you may have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim. We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency.
- If you are filling a prescription related to a medical emergency.
- If you are unable to obtain a covered drug in a timely manner from a network pharmacy that provides 24-hour service is within a reasonable driving distance.
- If you need a prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (including high cost and unique drugs).
What if I am prescribed a drug that is not on the formulary or is on the formulary but its use is restricted?
You, your appointed representative, or physician can request a coverage determination or
formulary exception by completing the Coverage Determination/Exception Request Form or calling Customer Service at 503-416-4100 in the Portland area or toll free at 800-224-4840, daily, 8 a.m. to 8 p.m. TTY/TDD users should call 1-877-416-4161.
How do I submit a paper claim to request reimbursement?
Download a Prescription Claim Form or call 503-416-4100 in Portland, OR, or
toll-free at 1-800-224-4840, daily, 8 a.m. to 8 p.m. (TTY/TDD users should call 877-416-4161) and ask for the form be mailed to you. Complete the form in its entirety and mail to:
RxAmerica
Attn: Member Reimbursements
221 Charles Lindbergh Drive
Salt Lake City, Utah 84116
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