Pharmacy Benefit FAQ

Capital Rx Inc is a pharmacy benefit manager contracted to provide cost-effective prescription drug benefits for Memorial Hermann Health Plan members and to improve member health and minimize their out-of-pocket costs.

A pharmacy benefit manager (PBM) processes and pays prescription drug claims for its members. It contracts with pharmacies and builds and maintains drug formularies. A PBM also negotiates discounts and rebates with drug manufacturers.

Capital Rx is our pharmacy benefit manager and manages the pharmacy benefits on behalf of Memorial Hermann Health Plan and its members.

Your health plan will provide the plan benefit information to Capital Rx automatically. You will also be issued a member ID card if you are new to our plan. Please provide this card to your pharmacy to process new prescriptions under your pharmacy benefit.

Helpful Advice – Remember to present the new member ID card to your pharmacy so that they can access your benefits. If you do not have the new member ID card handy, please call the Memorial Hermann Customer Service at (855) 645-8448 to request a temporary ID card. You may also call Capital Rx Pharmacy Help Desk to obtain your pharmacy claim processing information by calling (833) 502-3346.

When you visit your doctor, he or she may prescribe medicine for you. Here's how the plan works:

• Take your prescription and member ID card to the pharmacy to get your medicine.
• The pharmacist fills your prescription and checks with your pharmacy plan to see how much to charge you for your prescription.
• Because you have a pharmacy plan, you may pay less for your medicine - the amount you pay is called your cost-share. Your pharmacy plan pays the rest.
• Depending on how your health plan is designed, you may have to pay the full cost at the beginning of your plan year, until you meet your deductible. A deductible is the amount of money that you pay out-of-pocket for covered services, before your plan starts to pay.

A prescription drug plan, or pharmacy plan, is a part of your health care coverage. Prescription medicines can be expensive. When you have pharmacy coverage - or prescription drug coverage - your pharmacy plan may pay a portion of the costs of prescriptions your doctor or other health care professionals prescribe for you. These medicines can be something you take for only a short while, like an antibiotic to treat an infection. They can also be something that you take for a longer time, like medicine to treat high blood pressure, or insulin to treat diabetes.

We support pharmacy coverage by helping you:

• Order and refill your medicine
• Choose generic medicines that may lower your costs

You can find a participating retail pharmacy near you by calling Capital Rx Pharmacy Customer Services toll-free at (833) 502-3346.

Yes, please contact (800) 607-6861 or visit the website https://www.costco.com for more information on how to sign up for home delivery. After you enroll a prescription in mail order, Costco Mail Order will send your prescription or prescription refill after verifying your credit/debit card information. For more information, please scroll below to the section, Costco Mail Order.

Please see below a list of all Memorial Hermann pharmacy locations:

Yes we do, the specialty pharmacy is:

By using Memorial Hermann pharmacies, you get the benefits of having all your medications coordinated with your physicians using our electronic medical records and your medications being streamlined. This will enhance your experience, provider easy way to coordinate refills, and ensure you are getting the optimal treatment. To read more about benefits, see here.

Your pharmacy plan works with pharmacies all across the country to create a network. A network is a large group of pharmacies that have contracts with an insurance plan to offer covered products and services at a lower rate to insurance plan members.

• Pharmacy networks are usually very large and include major chain pharmacies as well as local independent pharmacies.
• You can also use an out-of-network pharmacy, but your plan might not pay for your prescriptions. This means your medicine may cost you more. In some cases, your plan might pay for part of your prescription, but you would have to file a claim for reimbursement.

A formulary is a list of drugs covered by your health plan. The list is designed to provide you and your physician with the most safe, effective drugs at the most reasonable cost. Health plans use the drug list to provide their members with effective drug therapies at reasonable costs. For this reason, using drugs from a drug list is important for both you and your health plan.

For the most up-to-date formulary status of your medication, please visit the online formulary for employer plans.

You have the option to get a brand name drug even if a generic equivalent is available. However, this option may cost more depending on your plan's coverage.

To determine the most up-to-date formulary status of your medication, please visit your member portal website or call Capital Rx Pharmacy Member Services at (833) 502-3346 for more information about your drug benefits.

If your provider wishes for you to continue receiving the medication that is not covered or excluded, please have your provider request an exception request process through CapitalRx.

For more information about the Capital Rx formulary, you may call Capital Rx Customer Service toll-free at (833) 502-3346 or ask your provider to call to start the exception request process.

Capital Rx Pharmacy Customer Care is available 24 hours a day, 7 days a week. Please call at: (833) 502-3346.

Memorial Hermann Specialty Pharmacy and Costco Specialty Pharmacy are just two specialty pharmacy vendors that Memorial Hermann Health Plan is using. Members can use any in-network specialty pharmacy vendor of their choice.

To learn more about Memorial Hermann Specialty Pharmacy. Please visit Specialty Pharmacy and by reading their Frequently Asked Questions.

Costco Specialty Pharmacy is another alternative specialty pharmacy benefit that we offer to our members. The process to fill a prescription is simple. Call a Costco Patient Care Specialist at (866) 443-0060 to get started.

Please go to the Costco Specialty Pharmacy Frequently Asked Questions page for additional resources.

Memorial Hermann Health Plan and Capital Rx have partnered with Costco Mail Order Pharmacy to provide your mail order prescription benefits.

No. You don't need to be a Costco Member to use Costco Mail Order Pharmacy.

You can register via mail or phone or via online. Below are the two methods to register for home delivery service with Costco Mail Order Pharmacy.

Option 1: Option 1: Traditional Mail Order Process - If you register for Costco using mail or phone process, it is called the Traditional Mail Order. Traditional Mail Order requires you to order all your prescriptions via mail or phone. You must complete the included patient profile form and submit it to Costco Mail Order Pharmacy. Traditional Mail Order also accepts personal checks and Electronic Funds Transfer as forms of payment.

Option 2: Online Ordering service requires you to order all your new prescriptions online at www.costco.com. You should create an online account. Please remember that each individual receiving medications must have their own unique email address in order to create an online account. All communication between you and the pharmacy will be done via email.

You can contact Costco Mail Order Pharmacy at (800) 607-6861. Please scroll down to download the Traditional Enrollment Form under “Additional Information” section below.

To register for an online account, you need to go to Costco.com and create an account.

Please Note: A Costco Membership is not required, you do not need to enter a membership number. Creation of an online login just requires an email address and a password. If you already have a Costco account, simply click login and log into your account.

Please use the following instructions to complete a mail order profile setup after creating your online login account or logging into your existing Costco account:

Step 1: After creating the account, hover over the Pharmacy link at the top, middle of the page.
Step 2: Click on the “Mail Order” option..
Step 3: From there, over on the right, click on Fill New Prescriptions - this will take you to your profile page where you can set up your personal information, drug allergies, insurance, payment, and shipping information. You can enter all the information..
Step 4: Please click and agree to the Terms of Service for Costco Mail Order..
Step 5: Finally, you click "Complete Profile," your registration for Pharmacy is complete, and you can start using the service immediately.

Step 1: After creating the account, hover over the Pharmacy link at the top, middle of the page..
Step 2: Click on the “Mail Order” option.
Step 3: From there, over on the right, click on Fill New Prescriptions – (this will direct you to Sign In).

Your doctor can reach out to Costco Mail Order Pharmacy directly or use electronic prescribing software (e-scripts) to select Costco Mail Order Pharmacy and to send prescriptions. Providers and Members can also call Costco Mail Order Pharmacy at (800) 607-6861 for any help with processing their prescription. For more information, please read the section titled “How do I order a new prescription using the Online Ordering service?” in the Costco Mail Order Pharmacy brochure. For the Costco Mail Order Pharmacy brochure in Spanish “¿Cómo pido una receta nueva usando el servicio de Pedidos en Línea?.”

Members need to register at Costco.com before they can fill or request refills for mail order prescriptions. Note: You do not need to be a Costco Member to use Costco Mail Order Pharmacy. Information from the new member ID card is needed to register and members can register by phone, mail or online. Home delivery forms and FAQs are available by scrolling down to the "Additional Information" section below.

Note: You should expect to receive your mail order prescriptions 14 days after Costco Mail Order Pharmacy receives your refill request. Make sure you have an adequate supply of your medication on hand to allow for this time period.

Yes, please reach out to Costco Mail Order Pharmacy, they allow members to enroll in the automatic refill program. Please be aware that prescriptions on auto-refill will still require your consent before we can fill them. A valid email address and payment method must be on file with Costco Mail Order Pharmacy in order to use the auto-refill system. To enroll your prescription in the auto-refill program, you can either enable auto-refill for each prescription yourself on the Refill Prescriptions page on the online Costco account, or Contact Costco Mail Order Pharmacy via phone at (800) 607-6861. Please note auto-refills will not be available for controlled substances and refrigerated medications.