Out-of-Network Coverage

Out-of-Network Pharmacy Coverage (if you have a Today's Options^® PFFS Medicare Advantage Prescription Drug Plan)

Today's Options PFFS has formed a network of pharmacies. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.

• The pharmacies in our network can change at any time.
• You can use our Pharmacy Locator or call us at 1-866-568-8921, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-877-907-2986) 7 days a week, for an up-to-date list.
• Formulary medicines may be covered in special circumstances, such as illness while traveling outside of the plan's service area (within the United States) where there is no network pharmacy.
• You may pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy.
• We will not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. For example, you may submit a claim for a Part D covered medication dispensed by a nonparticipating pharmacy for the following reasons:
• If you traveled outside of the plan's service area and ran out of (or lost) your medication or if you became ill and could not access a network pharmacy.
• If you were unable to obtain your medication in a timely manner within the service area. For example, there was no network pharmacy within a reasonable driving distance that provides 24/7 service.
• If your medication is not stocked regularly at an accessible network pharmacy.
• If your medication was dispensed from an emergency department, provider-based clinic, outpatient surgery facility, or other outpatient setting.
• If you received a vaccine at your doctor's office.
• If you were evacuated or displaced from your residence due to a state or federally declared disaster or health emergency.

Download the Direct Claims Form (PDF) to submit a claim for a Part D covered medication dispensed by a non-participating pharmacy.