Members

2017 iCare Family Care Partnership
Pharmacy Access


Where Can I Get My Prescriptions Filled?

iCare Family Care Partnership (HMO SNP) has formed a network of pharmacies. In most cases, your prescriptions are covered only if they are filled at the plan’s network pharmacies. A network pharmacy is a pharmacy that has a contract with the plan to provide your covered prescription drugs. The term “covered drugs” means all of the prescription and over-the-counter drugs that are covered by the plan.

Our Pharmacy Directory gives you a complete list of our network pharmacies – that means all of the pharmacies that have agreed to fill covered prescriptions for our plan members. You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies. Generally, benefits are only available at iCare-contracted network pharmacies. Besides retail pharmacies, iCare Family Care Partnership (HMO SNP) also includes home infusion and long-term care pharmacies in our network.

You can use the Pharmacy Directory to find the network pharmacy you want to use. This is important because, with few exceptions, you must get your prescriptions filled at one of our network pharmacies if you want our plan to cover (help you pay for) them.

We will send you a complete Pharmacy Directory upon request. If you don't have the Pharmacy Directory, you can download a copy from our website or ask for a copy from Customer Service. At any time, you can call Customer Service to get up-to-date information about changes in the pharmacy network, 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.

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.

For more information about iCare network pharmacies, call our Customer Service department from 8:00 am to 8:00 pm, 7 days-a-week at 1-800-777-4376 (TTY: 1-800-947-3529). Or, write to: iCare Family Care Partnership (HMO SNP), 1555 N. RiverCenter Drive, Suite 206, Milwaukee, WI 53212.

When Can I Use a Pharmacy that is Out-of-Network?

Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine 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 from 8:00 am to 8:00 pm, 7 days-a-week at 1-800-777-4376 (TTY: 1-800-947-3529) to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an out-of-network pharmacy for the reasons listed below, you may have to pay the full cost (rather than paying just co-payment) when you fill your prescription. You may ask us to reimburse you for our share of the cost by submitting a paper claim. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy. If you have Medicare Part D, any amount you pay, or others pay on your behalf, for a covered Medicare Part D drug will help you qualify for catastrophic coverage. If we do pay for the drugs you get at an out-of-network pharmacy, you may still pay more for your drugs than what you would have paid if you had gone to an in-network pharmacy.

The following are a few exceptions when we will pay for a prescription filled at a pharmacy outside of our network.

  • You are or plan to be away from our Plan’s service area
    If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need.
    If you are traveling within the United States and territories 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 will 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. To learn how to submit a paper claim, please refer to “How to ask us to pay you back or to pay a bill you have received,” in Chapter 6, Section 2 of this EOC/Member Handbook.
    We have network pharmacies outside of the service area where you can get your drugs covered as a member of our Plan. You can call Customer Service (phone number on front cover) to find out if there is a network pharmacy in the area where you are traveling. If there are no network pharmacies in that area, Customer Service may be able to make arrangements for you to get your prescriptions from an out-of-network pharmacy.
    We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency.
  • Getting a prescription because of a medical emergency or urgent care.
    We will cover prescriptions that are filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgent care. In this situation, you will 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 form. To learn how to submit a paper claim, please refer to “How to ask us to pay you back or to pay a bill you have received,” in Chapter 6, Section 2 of this EOC/Member Handbook.
  • Other times you can get your prescription covered if you go to an out-of network pharmacy
    We will cover your prescription at an out-of-network pharmacy if at least one of the following applies
    1. a. 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.
    2. b. If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail pharmacy (including high cost and unique drugs).
    3. c. If you have Medicare coverage and are getting a vaccine that is medically necessary but not covered by other Medicare benefits

How Do I Submit a Paper Claim?

Under some circumstances you may have to submit a paper claim to request reimbursement of costs you have incurred. Send us your request for payment, along with your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records.

The paper claim should include original receipts from your provider that includes the following information:

  • Provider name and NABP/NCPDP/NPI number
  • Provider address and telephone number
  • Date of service
  • Amount Paid
  • For drugs
    • Name of the prescription and strength
    • National Drug Code (NDC) for the prescription
    • Quantity of medication
    • Days supply of medication
    • Directions for use of the prescription
  • For other services
    • Procedure description
    • Procedure code
    • Diagnosis code
    • Quantity of service

Also please be sure and include your name, identification number, and a contact phone number in case we need to reach you.

You may submit paper claims to the following address (use this address even if you are not eligible for Medicare):

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

To inquire on the status of your paper claim, you may contact us at 1-800-777-4376, 8:00 a.m. to 8:00 p.m., seven days-a-week (TTY Users should call 1-800-947-3529).

All requests for paper claim reimbursements need to be received at the above noted address by no later than 365 days after the date of service (drug claims) to be considered for coverage.

If you submit a paper claim asking us to reimburse you for a prescription drug that is not on our formulary or other service that is subject to coverage requirements or limits, your doctor may need to submit additional documentation supporting your request.

Please be sure to contact Customer Service if you have any questions. If you don’t know what you owe, or you receive bills and you don’t know what to do about those bills, we can help. You can also call if you want to give us more information about a request for payment you have already sent to us.

Contact Us

Questions? Call us at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m. Our mailing and walk-in address is: Independent Care Health Plan, 1555 N. RiverCenter Dr., Suite 206, Milwaukee, WI 53212.


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Modified: 3/29/2017

 

  
  
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