Benefits Enrollment & Reference Guide - Harford County Public ...

CareFirst Drug Program
Additional Information
Non-Participating Pharmacy
If a pharmacy is non-participating you will be required
to pay the full cost of the prescription at the time of
purchase. Claims for these prescriptions should be
submitted on the appropriate claim form.
Argus Health System claim forms are available on the
CareFirst website at www.carefirst.com or you can
contact Member Service at Argus Health Systems:
(800) 241-3371.
Refill Guidelines
Refills will not be authorized on any prescriptions until
25% or less of the original quantity is remaining in your
possession (75% has been used).
Vacation Supply
Since your program has a nationwide network, in most
cases there are several area participating pharmacies
available when on vacation. You may obtain a written
prescription from the physician prior to leaving and
obtain a list of pharmacies in the area in which you will
be traveling.
Generic Drug Appeal Process When
Medically Necessary
1. When members cannot take the generic medication
due to medical reasons, the member’s physician
would be required to supply medical justification for
prescribing the brand medication.
2. The member’s physician must initiate the request
process.
3. Requests will be forwarded directly to the Carefirst
Pharmacy Management Department. Requests will
be reviewed and turned around within 2 business
days when submitted during business hours.
4. Once the appeal is received and approval is given
by Carefirst pharmacy department, the prescribing
physician and the pharmacy are provided notification
of the appeal, and the pharmacy will be requested to
reprocess the claim.
5. The approval of a brand medication will be valid for 12
months from the original fill date of the medication.
If you are traveling out of the country for less than
one month, call Argus Member Services at (800)
241-3371 to receive authorization for an additional
short-term supply.
For additional quantities greater than one month,
please contact CareFirst Member Services using the
number on your ID card.
Please call no less than 10 days in advance of your
departure date to request the additional supply.
26 Harford County Public Schools – Benefits Enrollment & Reference Guide