Presbyterian MediCare PPO 2007 Practitioner and Provider Directory

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to fill your prescription, you can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described later. Can the list of network pharmacies change Yes, Presbyterian MediCare PPO may add or remove pharmacies from our pharmacy directory. To get current information about Presbyterian MediCare PPO network pharmacies in your area, please visit our website at www.phs.org or call our Member Services Department at (505) 923-6060 or toll free 1-800-797-5343, Monday through Sunday 8 a.m. to 8 p.m. (TTY/TDD Users should call 1-888-625-8818.) How do I find a Presbyterian Prescription Drug Plan network pharmacy in my area Pharmacies are listed in this Directory by type of pharmacy, then alphabetically by city. Or, you can visit our website at www.phs.org or call our Member Services Department at (505) 923-6060 or toll free 1-800-797-5343, Monday through Friday 8 a.m. to 8 p.m. (TTY/TDD Users should call 1-888-625-8818.) How do I fill a prescription at a network pharmacy To fill your prescription at a network pharmacy, you must show your Presbyterian MediCare PPO Member ID card. If you do not have your 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 co-payment). If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Presbyterian MediCare PPO 2007 Member Handbook/ Evidence of Coverage or call Member Services. How do I fill a prescription through Presbyterian MediCare PPO’s mail order pharmacy service To get mail order forms and information about filling your prescriptions by mail, call Member Services at (505) 923-6060 or toll free 1-800-797- 5343, Monday through Sunday 8 a.m. to 8 p.m. (TTY/TDD Users should call 1-888-625-8818.) Please note that you must use the Presbyterian MediCare PPO mail order service. Prescription drugs that you get through any other mail order service are not covered. When you order prescription drugs by mail, you must order at least a 67-day supply, and no more than a 90-day supply of the drug. You are not required to use mail order prescription drug services to obtain an extended supply of maintenance medications. Instead, you have the option of using a retail pharmacy in Presbyterian Medicare PPO’s network to obtain a maintenance supply of medications. If you want more information about mail order pharmacy services, call our Member Services Department at (505) 923-6060 or toll free 1-800-797-5343, Monday through Sunday 8 a.m. to 8 p.m. (TTY/TDD Users should call 1-888-625-8818.) Please allow 2 weeks for delivery of your medication from mail order service. You may also obtain an extended supply of covered prescription drugs (up to a 90 day supply) through selected network retail pharmacies. However, your cost-sharing will be higher if you use these selected network retail pharmacies instead of our mail order pharmacy service. Please call our Member Services Department at (505) 923-6060 or toll free 1-800-797-5343, (TTY/TDD Users should call 1-888-625-8818), Monday through Friday Sunday, 8 a.m. to 8 p.m. for more information about which retail pharmacies offered extended supplies of a vi
prescription drug. If there is a delay in obtaining your medication from mail order, arrangements will be made to allow a member to obtain a 30 day prescription drug supply at a network pharmacy. Filling prescriptions at a non-network pharmacy: If you fill your prescription at an out-of-network pharmacy, you will have to pay the full cost of the prescription yourself, at the time of service, not just the co-payment. In this situation, you can ask us to pay our share of the cost by filling out a pharmacy claim form and sending it to us. The following are a few exceptions when we will pay for a covered prescription drug filled at a pharmacy outside of our network. Getting coverage when you travel or are away from the 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. You may be able to order your prescription drugs ahead of time through our mail order pharmacy service. 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 the paper claims process described later. You can also call Member Services 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, Member Services 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. 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 outof-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 the paper claims process described later. 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-ofnetwork pharmacy if at least one of the following applies: • 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). vii
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Retail Pharmacies Presbyterian Medi
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Albuquerque (continued) 8301 Golf C
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Santa Fe Del Norte Pharmacy 1691 Ga
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Mail Order Pharmacies Presbyterian
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Long-Term Care Pharmacies Presbyter
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Presbyterian MediCare PPO Long-Term
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Presbyterian MediCare PPO Indian He
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Presbyterian MediCare PPO Index by
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Glasscock, Frances E, CNS Presbyter
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Hiltz, William F, MD Presbyterian M
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Munoz, Gabriela U, PhD Presbyterian
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Schneider, Linda, DC Presbyterian M
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Conkling, Patricia, CNP Presbyteria
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Markwell, Robert E, MD Presbyterian
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Veytia, Laura E, PA Presbyterian Me
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Wetherill, Timothy F, MD Presbyteri
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Khawaja, Mubarak, MD Presbyterian M
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Raley's Pharmacy Presbyterian MediC
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Ingimundson, Tawnya, CNP Presbyteri
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Watts, Amy C, OD Presbyterian MediC
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Kaufman, Paul W, MD Presbyterian Me
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Tularosa Medical Center Presbyteria
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Bass, Harry, MD Presbyterian MediCa
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