Pharmacy Use Outside of the Yale Health Center
Mail Order
Magellan Rx Home offers our members the convenience of home delivery avoiding trips to the Yale Health Pharmacy to pick up your medications.
Magellan Rx Home is in our network so you only pay your copays and there aren’t any forms to submit.
Out-of-Network Pharmacy
When you use an outside pharmacy (not the Yale Health Pharmacy at 55 Lock Street) you will be treated as a cash customer and they will not check to see if your prescription is covered under your insurance plan. This means that when you submit your claim it could be denied because:
- the drug is not covered under the benefit
- the drug required prior authorization
- it is too early to fill the prescription
- the Yale Health co-pay is greater than the amount you paid for the drug (your cost for the drug is $28, but it is a Tier 3 drug, so the co-pay is $30)
- there is no “days supply” listed on the receipt (see instructions on claim form)
Pharmacy Reimbursement for an Outside Pharmacy
You are responsible for the greater of 20% of the cost or the co-pay.
Example:
Cost of drug purchased at outside pharmacy: $120
Co-pay: $20
20% of your cost of $120: $24
You are responsible for $24 (when purchased at an outside pharmacy). If you had the prescription filled at the Yale Health Pharmacy you would only need to pay $20.
Your pharmacy benefit is subject to the rules and limitations of the formulary (Member Coverage Booklet or Student Handbook) even when you use an outside (out-of-network) pharmacy.
For all of the reasons above plus the care that you receive because our pharmacists have direct access to your clinicians and your electronic health record – you may want to reconsider using the Yale Health Pharmacy.
If you use an outside pharmacy, electronically submit your claim for reimbursement of outside pharmacy expenses, you will need your member ID number and the Yale Health RxBIN#017449; or mail the paper Pharmacy Claim Form.