Pharmacy Questions Answered
Welcome to Tufts Health Plan Medicare Preferred's Pharmacy page.
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Still Have Questions?

  • Does Tufts Health Plan Medicare Preferred make Changes and/or Updates to the Formulary throughout the year?

    Tufts Health Plan Medicare Preferred may add or remove drugs from our formulary during the year. The cover page of the posted formulary PDFs include the last date the document was updated. For questions call Customer Relations.

  • What happens if you were unaware of changes or updates to our Formulary?

    The 2014 Prescription Drug Transition Process document can answer the following questions.

    • What if your drug is no longer covered?
    • What if your drug is excluded from coverage?
    • What if you just joined Tufts Medicare Preferred and did not know that your drug was not covered?
    • What if your drug requires Prior Authorization?
    • What if your drug is part of a Step Therapy program?
  • What If I'm out-of-network and run out of my prescription?

    Our Pharmacy Finder gives you a complete list of our network pharmacies - that means all of the pharmacies that have agreed to fill covered prescriptions for our plan members. In most cases, your prescriptions are covered only if they are filled at the plan's network pharmacies (retail or mail-order). Tufts Health Plan Medicare Preferred has contracts with Pharmacies that equal or exceed requirements for pharmacy access in your area.

    If you are traveling within the U.S., but outside of the Plan's service area and you become ill or if you lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy if you follow all other coverage rules identified within your Evidence of Coverage. In this situation, you will have to pay the full cost (rather than paying just your copayment) when you fill the prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form.

    There may be 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-of-network pharmacy if at least one of the following applies:

    • If you are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service.
    • If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).

    Before you fill your prescription in either of these situations, call Customer Relations to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an out-of-network pharmacy for the reasons listed above, you will have to pay the full cost (rather than just paying your copayment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form.

    HMO Pharmacy Directory >
  • What if I need Extra Help to pay for my prescriptions?

    If you qualify for extra help, your premium and drug costs will be lower. When you join a plan offered by Tufts Health Plan Medicare Preferred, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. The premiums listed do not include any Part B premium the member may have to pay. The premiums listed are for both medical services and prescription drug benefits.

    For specific information about low income subsidy please click here.

    Beneficiaries interested in qualifying for extra help with Medicare Prescription Drug Plan costs should call:

    The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048 (24 hours a day/7 days a week); or Your State Medicaid Office.

  • What if I need to request coverage for Prescriptions? (Universal Pharmacy Form)

    This form is used to request coverage for medications that require prior authorization, step therapy exceptions, quantity limit exceptions, tier exceptions and coverage of non-formulary or new-to-market drugs. Your prescriber must be involved in filling out this form since he or she will need to provide information regarding the medical necessity of your request.

  • How can I find out more about other member's experiences with Tufts Health Plan Medicare Preferred's Prescription Coverage?

    Interested in learning more about the aggregate number of appeals, grievances and exceptions filed with Tufts Health Plan Medicare Preferred? Call Customer Relations for a copy of our Tufts Medicare Preferred HMO Appeals and Grievances Report.