Usually, we only cover drugs obtained from an out-of-network pharmacy in limited circumstances:

  • When you travel out of the plan’s service area.
  • If you lose or you lack your medication, or get sick and need a covered drug immediately and you do not have access to a network pharmacy.
  • If you cannot obtain a covered drug in your service area in a timely manner due to lack of availability of a network pharmacy.
  • If your covered drug is provided in an out-of-network pharmacy while you are in an emergency room, in a provider’s clinic, outpatient surgery, or in another facility.
  • If a covered prescription is not in inventory at an accessible in-network retail pharmacy

For detailed information consult your plan’s Evidence of Coverage (Chapter 5, Section 2.5 “When can you use a pharmacy that is not in the plan’s network?”) or call Member Services.

Please note that if you do go to an out-of-network pharmacy, you may have to pay the full cost (rather than paying just your copay) when you fill your prescription. You can request a reimbursement for our share of the cost by submitting a claim form. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy, as any amount you pay will help you qualify for catastrophic coverage.

 

 

MMM of Florida, Inc. is an HMO plan with a Medicare contract. Enrollment in MMM of Florida depends on contract renewal. This information is not a complete description of benefits. Call 1-844-212-9858 (TTY: 1-833-523-2620) for more information. Every year, Medicare evaluates plans based on a 5-star rating system.  MMM of Florida, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. MMM of Florida, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-212-9858 (TTY:1-833-523-2620). MMM of Florida, Inc. konfòm ak lwa sou dwa sivil Federal ki aplikab yo e li pa fè diskriminasyon sou baz ras, koulè, peyi orijin, laj, enfimite oswa sèks. ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-844-212-9858 (TTY:1-833-523-2620).

 

Updated: October 2018

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