How to file a claim

If you get a prescription filled at an out-of-network pharmacy for one of the reasons below, you can request that we reimburse you. We make decisions about reimbursement based on your Evidence of Coverage.

Circumstances for out-of-network prescription coverage:

  • Medical emergencies
  • If a pharmacy that is open 24 hours is not within a reasonable driving distance
  • You cannot get the prescription you need because an in-network pharmacy does not have it in stock
  • You are traveling outside your plan service area and run out of or lose your covered Part D drugs
  • You become ill and need a covered Part D drug, and cannot access a network pharmacy

To submit a claim, please complete our pharmacy paper claim form. Mail it and your prescription receipt to the address on the form. You will need to submit this claim within 60 days of getting your out-of-network prescription filled.

Need help filing a claim?

Please contact us if you need help filing a claim. Please call our Moda Health Customer Service at 503-265-4709 or toll-free at 888-786-7509. TTY users, dial 711. Customer Service is available to help you from 7 a.m. to 8 p.m., Monday through Friday. Weekend calls are forwarded to voicemail and returned the next day.

Last updated Sep. 26, 2019

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