Frequently Asked Questions - FAQ

 

How do I fill a prescription?

What is a copayment? How do I know what to pay for prescription drugs?

Why are there different copayments for different drugs?

What happens when my doctor prescribes a Tier Three (highest copayment amount) drug?

What if I want the brand name drug - not the generic?

I have always paid the same copayment amount. The last time I filled my prescription the copayment amount increased. Why?

Why was my prescription not filled by my pharmacy?

What happens if I am away from home and need prescription medication?

How do I get my prescriptions filled by mail?

I am going to be away for an extended period of time. What do I do about the medications I take on a continuing basis?

How do I receive a copy of the formulary/drug list?

Still have questions? You can email us.

 

How do I fill a prescription?

Simply take your prescription and your ConnectiCare ID card to any participating pharmacy. Our pharmacy network includes the major chains as well as many local drug stores.  


What is a copayment? How do I know what to pay for prescription drugs?

A copayment is the predetermined fee you pay for covered healthcare benefits – in this case, prescription drugs. Your specific copayment for each tier can be found in your Benefit Summary. Your copayment is based on the tier in which the drug is listed. 

Why are there different copayments for different drugs?

The cost of drugs varies widely, even among medications that treat the same condition. Generic drugs are the least expensive and therefore have the lowest copayment. Brand name drugs cost on average three to four times as much as generic drugs and therefore have a higher copayment.

What happens when my doctor prescribes a Tier Three (highest copayment amount) drug?


The prescription will be filled at a participating pharmacy at the highest copayment amount.

Most prescription drugs that are covered by ConnectiCare’s plan are from Tier One or Tier Two. But if you’re using a drug from Tier Three, ask your physician if a Tier One or Two alternative is available. Your physician will be able discuss the available alternatives with you.


What if I want the brand name drug - not the generic?

When generic drugs are available, your prescription drug program covers only the cost of the generic. If you or your physician request the brand name when a generic is available, an additional payment is required. This additional payment represents the cost difference between the generic and brand name.

I have always paid the same copayment amount. The last time I filled my prescription the copayment amount increased. Why?

There are several reasons why your copayment could increase.

  • Employers purchase health benefits on a yearly basis. If you or your employer made changes in your benefits, prescription copayment levels may have also changed.
  • ConnectiCare reviews drugs several times throughout the year. One of your medications may have been moved to a new copayment tier. These changes are communicated quarterly in our member newsletter and also in the pharmacy portion of the Connecticare.com web site.
  • Your physician may have written you a new prescription for a different quantity. Copayments are based on the number of month’s supply dispensed to you by the pharmacy.

Why was my prescription not filled by my pharmacy?

A limited number of medications covered by ConnectiCare need prior approval from the prescribing physician. Drugs require prior approval in these situations:

  • Drug's that should be monitored to insure appropriate use
  • The medication has been prescribed in a quantity over the set limit

Also some drugs are not covered by ConnectiCare, including:

  • Drugs used for sexual dysfunction 
  • Drugs used for weight loss
  • Drugs used for smoking cessation

What happens if I am away from home and need prescription medication?

Look for a participating pharmacy. Most pharmacy chains all over the USA participate with the ConnectiCare network.

If you use a non-participating pharmacy, you are responsible for the full cost of the prescription at the time of purchase. However, if there was a medical emergency and you paid for the prescription, keep your receipt and fill out the Prescription Drug Claim form for reimbursement.


How do I get my prescriptions filled by mail?

Most plans offer home delivery of prescription medications. Refer to your Benefit Summary to see if you're covered for mail order. Our mail order service offers a convenient way to receive up to a three-month supply of medications that you are taking, and will be taking on an on-going basis.

  • Simply have your physician write a prescription for a three-month supply.
  • Fill out the mail order form.
  • Enclose the copayment and allow 14 days for your prescription to arrive.

I am going to be away for an extended period of time. What do I do about the medications I take on a continuing basis?

If you are away from home or plan to be away for an extended period of time, please call Member Services at 1-800-251-7722, and we may override the day supply limit. Or if you have a new prescription bring this to a network pharmacy anywhere in the United States and you will only be responsible for your standard copayment amount.

How do I receive a copy of the Drug List?

There are three simple ways to obtain one. You can e-mail us, call Member Services or  you can view ConnectiCare's  Prescription Drug List.* This version has a search function that will easily allow you to find your medication.