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Out-of-network/non-contracted providers are under no obligation to treat Johns Hopkins Advantage MD members, except in emergency situations. Enrollment in Johns Hopkins Advantage MD, HMO, PPO or D-SNP (HMO) depends on contract renewal.

Johns Hopkins Advantage MD D-SNP is an HMO D-SNP plan with a Medicare contract and a State of Maryland Medicaid contract. Johns Hopkins Advantage MD is a Medicare Advantage Plan with a Medicare contract offering HMO and PPO products. From April 1–September 30, you will need to leave a message on weekends and holidays. If you have any questions, you can contact us 24 hours a day, seven days a week. If you don’t know what you should have paid, or if you received bills and you don’t know what to do about those bills, we can help. Mail your request for payment together with any bills or receipts to us at this address: You don’t have to use the form, but it will help us process the information faster. Medicare Part D Prescription Claim form.To make sure you are giving us all the information we need to make a decision, you can fill out our claim form to make your request for payment. It’s a good idea to make a copy of your bill and receipts for your records. Send us your request for payment, along with your bill and documentation of any payment you have made. You can ask us to reimburse you for our share of the cost.

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If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. If you do need to go to an out-of-network pharmacy for any of the reasons listed above, the plan will cover up to a one-month supply of drugs. Note: It may cost you more to obtain your medications at an out-of-network pharmacy. If you are experiencing any of these situations, you can call us 24 hours a day, seven days a week so we can see if there is a network pharmacy nearby. A vaccine or drug administered in your doctor’s office.If you are evacuated or otherwise displaced from your home because of a Federal disaster or other public health emergency declaration.The prescription is for a drug that is out-of-stock at an accessible network retail or mail service pharmacy (including high-cost and unique drugs).You are unable to get a covered drug in a time of need because there are no 24-hour network pharmacies within a reasonable driving distance.The prescription is for a medical emergency or urgent care.Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy: Generally, Johns Hopkins Advantage MD covers drugs filled at out-of-network pharmacies only when you are not able to use a network pharmacy. You can download, print, fill out, and submit the mail service order form to CVS/caremark to enroll. Ask your doctor to submit your prescriptions electronically, by fax, or over the phone. You will be asked to provide your doctor’s information, medication, and prescription payment method. We are available 24 hours a day, seven days a week. PPO members, call 87 (TTY: 711) HMO members, call 87 (TTY: 711). Click “Order Prescriptions,” then click “Request a New Prescription” to enter your medication. If your order does not arrive within ten days, you may also call us 24 hours a day, seven days a week. Provide the representative with your ID number and prescription number(s). If you need to request a rush order because of a mail-order delay, you may contact Customer Care to discuss options which may include filling at a local retail pharmacy or expediting the shipping method. If the mail-order pharmacy expects the order to be delayed, they will notify you of the delay. Usually a mail-ordered prescription will get to you in no more than ten days. However, Advantage MD D-SNP may fill up to a 90-day supply for all drugs. Drugs in Tier 5 are only available as a 30-day supply. Our plan’s mail order service allows you to conveniently order up to a 100-day supply of medication on Tier 1 and up to a 90-day supply of medication on Tier 2 through Tier 4 at two times the 30-day copay, saving you money and time.

Generally, the drugs provided through the mail order service are drugs that you take on a regular basis for a chronic or long-term medical condition. For certain kinds of drugs, you have the option to sign up for your plan’s network mail order services and get prescription drugs shipped to your home.