Out of Network Pharmacy Coverage

Out-of-Network Pharmacy Coverage

American Health Medicare covers prescription drugs under the Medicare Part D that are included in the plan’s drugs list (formulary) through an extensive network of contracted pharmacies. We have approximately 1,036 pharmacies throughout the island including the big pharmacy chains such as Kmart, Wal-Mart, Walgreens, CVS Caremark, and El Amal; and approximately 64,499 in the United States.

You may go to any network pharmacy of your preference when filling a prescription. To find a pharmacy you can look in our Provider Directory, visit our website (www.ahmpr.com) or call Customer Services Department at 1-888-620- 1919 Monday to Sunday from 8:00 AM to 8:00 PM. TTY users should call 1-866-620- 2520.

You will pay the total cost of your prescription drugs when filling a prescription in an out-of-network pharmacy because you do not have access to a network pharmacy. You must request an original receipt. You must submit this receipt when requesting a reimbursement from the plan. The following information should be included when submitting the reimbursement request:

Member Information:

• Member Name
• ID number (as shown in your membership card)
• If you have any other health plan: Coordination of Benefits (COB) - information on any other active health plan (in addition to AmericanHealth Medicare). If you do not have any other plan, answer No.
• Si decidió utilizar el formulario, favor de firmar el documento e indique la fecha.

Prescription Drugs and Pharmacy Information:

• Pharmacy Name
• Pharmacy Address
• Telephone number
• Rx number
• Date that prescription was filled
• DEA doctor’s number
• National Drug Code
• Prescription Drug Name and dosage
• Amount supplied and days
• Amount paid for prescription

You can complete the Reimbursement Form and send it through mail at:

• American Health Medicare

• Claims Department

• PO Box 11320

• San Juan, PR 00922

If you decide to use the Reimbursement Request Form, please fill out all the information in the form and sign it. Once we receive your Reimbursement Request form, we will evaluate your request as soon as all the information is complete. If some information is missing, we will request said information from you.

We recommend that you use our network pharmacies to fill your prescriptions. This way you will only pay the corresponding copayments in accordance with your plan’s prescription drugs coverage.

Last Updated 06/09/2011