Filling My Prescriptions

Filling My Prescriptions

Where Can I Get My Prescriptions Filled?

Members must use network pharmacies to obtain their prescription drugs, except under non-routine cases when you cannot make it to a network pharmacy. A network pharmacy is a pharmacy that has contracted with the iCare, where beneficiaries access prescription drug benefits provided by the iCare. In most cases, your prescriptions are covered only if they are filled at a network pharmacy. We have contracted with over 1,000 retail pharmacies throughout the State of Wisconsin, which equals or exceeds the Centers for Medicare and Medicaid (CMS) requirements for pharmacy access in your area. Click here to see what pharmacies are in our network.

If you need help finding a network provider and/or pharmacy, please call Customer Service at 1-800-777-4376 or visit www.icarehealthplan.org to access our online searchable directory. If you would like a Provider or Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email info@icare-wi.org.

Filling Prescriptions Outside the Network

We have network pharmacies outside of the service area where you can get your drugs covered as a member of our plan. Generally, we only cover drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions filled at an out-of-network pharmacy. Before you fill your prescription in these situations, call Customer Service to see if there is a network pharmacy in your area where you can fill your prescription. If you go to an out-of-network pharmacy for the reasons listed below, 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 claim form. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy so that any amount you pay will help you qualify for catastrophic coverage.

We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:

  • If you are traveling within the United States and territories and become ill, lose or run out of your prescription drugs
  • If the prescriptions are related to care for a medical emergency or urgent care
  • If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24 hour service
  • If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (including high cost and unique drugs)
  • If you are getting a vaccine that is medically necessary but not covered by Medicare Part B and some covered drugs that are administered in your doctor's office

We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency.

How Do I Submit a Paper Claim?

When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy for one of the reasons listed above, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription. When you return home, simply submit your claim and your receipt to the following address:

  • Independent Care Health Plan
  • 1555 N. RiverCenter Dr., Suite 206
  • Milwaukee, WI 53212

Upon receipt, we will make an initial coverage determination on the claim.

Notification:
By clicking the links above, you may be leaving the icarehealthplan.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the icarehealthplan.org website. These external links are not the responsibility of, or under the control of iCare. Independent Care Health Plan disclaims responsibility for the content and privacy policies of the owners/sponsors of the outside websites.

Modified: 7/24/2017
 

Independent Care Health Plan (iCare) is a Medicare Advantage HMO SNP organization with a Medicare contract and a contract with the State Medicaid program. Enrollment in any iCare plan depends on contract renewal. Plans are available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The Part B premium is covered by the State if you are a full-dual member. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

  • H2237_IC1453 Approved
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
  • Customer Service: 1-800-777-4376
    • 24 hours-a-day, 7 days-a-week
    • (Office Hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.)
  • TTY: 1-800-947-3529
  • Fax: 414-231-1092
  • All content and images unless otherwise indicated are
  • Copyright © 2017 Independent Care Health Plan