Pharmacy FAQs

Click on any question to find the answer below.

What is a network pharmacy?

Can the list of network pharmacies change?

How do I find a network pharmacy in my area?

How do I fill a prescription at a network pharmacy?

Can I get more than a 31-day supply of my medications?

How do I fill a prescription through the mail-order pharmacy service?

When can I get a prescription filled at a non-network pharmacy?

What if I need a prescription because of a medical emergency or because I needed urgent care?

How do I submit a claim by mail?

Are home infusion pharmacies part of the pharmacy network?

Are long-term care pharmacies part of the pharmacy network?

Are Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies part of the pharmacy network?


Q: What is a network pharmacy?
We call the pharmacies on this list our "network pharmacies" because we have made arrangements with them to provide prescription drugs to members of all PriorityMedicare plans. A network pharmacy is a pharmacy where beneficiaries get their prescription drugs provided by their PriorityMedicare plan. In most cases, your prescriptions are covered ONLY if they are filled at a network pharmacy or through our mail-order pharmacy service. Once you go to one, you are not required to continue to go to the same pharmacy; you can go to any of our network pharmacies.


Q: Can the list of network pharmacies change?
Yes, PriorityMedicare may add or remove pharmacies from our pharmacy directory from time to time. To get current information about network pharmacies in your area, check the Pharmacy Directory on this website or contact our Customer Service staff.

Q: How do I find a network pharmacy in my area?
The Pharmacy Directory lists network pharmacies alphabetically by city or town in Michigan, and it includes their addresses and phone numbers. We also have a network of regional and national chain pharmacies; you can go to any location of those chains, even when you're outside Michigan, and still be in-network. If you want help deciding which pharmacies are most convenient to you, you can use our interactive Find a Doctor tool online to search for pharmacies near you (this will take you outside the Medicare section of our website). Or contact us and a Customer Service representative will help you.
Go to the list of network pharmacy chains.


Q: How do I fill a prescription at a network pharmacy?
To fill your prescription at a network pharmacy, you must show your PriorityMedicare plan member ID card. If you do not have your PriorityMedicare plan ID card with you when you fill your prescription, you may have to pay the full cost of the prescription (rather than paying just your copayment). If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us by mail (see instructions below).


Q: Can I get more than a 31-day supply of my medications?
Yes. There are two ways to get an extended supply of any drug on our formulary. You can use the mail-service pharmacy to order 90-day supplies, and you will pay only two copayments for that three-month supply, saving you money. Or, you can go to any select retail network pharmacy for a 90-day supply. You will need to pay three copayments for your 90-day supply, but it will save you two trips to the pharmacy.


Q: How do I fill a prescription through the mail-service pharmacy?
To get prescriptions filled by mail, you must use our network mail-service pharmacy, Walgreens Mail Service. Prescription drugs that you get through any other mail order service are not covered. You can download and fill out the registration and order form (below) to mail in with your first prescription, or call Customer Service for help ordering prescriptions by mail.
Download the Walgreens Mail Service Registration and Order Form (coming soon)

Please allow two weeks for delivery from the date that you mail your order. If your order does not arrive before you run out of your medication, contact us to get a local refill of your medication.


Q: When can I get a prescription filled at a non-network pharmacy?
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. Then you can ask us to reimburse you for our share of the cost by submitting a claim form. For instructions see the question below, "How do I submit a claim by mail?"

You can also call us 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.

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

Other times you can get your prescription covered if you go to an out-of network pharmacy:

•  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 for a drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (including high-cost and unique drugs).

In these situations, 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 (see instructions below).


Q: What if I need a prescription because of a medical emergency or because I needed 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 claim through the mail.


Q: How do I submit a claim by mail?
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 because of the reasons listed above, the pharmacy may not be able to submit the claim directly to us and you will have to pay the full cost of your prescription. When you return home, simply submit your claim using our claim form and your receipt to the following address:

        GTESS Operations Center
        P.O. Box 853923
        Richardson, TX 75085-3923

        ATTN: Priority Health Claims

Download a Claim Form (99K PDF*)

Upon receipt, we will make an initial coverage determination on the claim. Please refer to the PriorityMedicare plan Evidence of Coverage booklet that you received when you enrolled, or contact us for more information on initial coverage determinations.


Q: Are home infusion pharmacies part of the pharmacy network?
Yes. Check the Pharmacy Directory for home infusion pharmacies. PriorityMedicare plans will cover home infusion therapy if:

• Your prescription drug is on the PriorityMedicare formulary (approved drug list);
• PriorityMedicare approves your prescription drug for home infusion therapy;
• Your prescription is written by a doctor; and
• You get your home infusion services from a PriorityMedicare network pharmacy.
  

Q: Are long-term care pharmacies part of the pharmacy network?
In some cases, residents of a long-term care facility may access their prescription drugs through their long-term care pharmacy. For a list of long-term care pharmacies in our network, see the Pharmacy Directory.


Q: Are Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies part of the pharmacy network?
Yes, Native Americans and Alaska Natives have access to I/T/U Pharmacies through the PriorityMedicare pharmacy network. See the Pharmacy Directory for a list, or call Customer Service.



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