Optima Medicare Out-of-Network Pharmacy Coverage

Optima Medicare PPO members are guaranteed out-of-network access to prescription drugs when:

• Traveling outside the plan’s service area and runs out or loses the covered Part D drugs or becomes ill and needs a covered Part D drug, and cannot access a network pharmacy;
• Not able to obtain a covered Part D drug in a timely manner within the plan’s service area because, for example, there is no network pharmacy within a reasonable driving distance that provides twenty-four hour service;
• Filling a prescription for a covered Part D and that particular drug (for example, an orphan drug or other specialty pharmaceutical) is not regularly stocked at an accessible network retail or mail-order pharmacy;
• Provided covered Part D drugs dispensed by an out-of-network institutional-based pharmacy while a patient is in an emergency department, provider-based clinic, outpatient surgery, or other outpatient setting.