- Active Health
- Retiree Health
- DB Pension
- DC Pension
- SUB Plan
Generic Drug: $5 Co-payment per Prescription – for up to a 30-day supply
Brand-Name Drug: $15 Co-payment per Prescription – for up to a 30-day supply
You may go to any non-network pharmacy of your choice. Under this Plan, you must contact the Administrative Office to request a direct member reimbursement form for purchasing prescriptions from non-participating pharmacies. You will be reimbursed for the prescription based on a limited formula, less a co-payment of $5 for each generic drug prescribed or $15 for each brand-name drug prescribed, up to a 30-day supply.
Under this Plan, you may be responsible for most of the drug cost, therefore you are encouraged to use the Citizens Rx Walk-In Pharmacy or Mail Service Prescription Drug Plan whenever possible. This Non-Participating Pharmacy Reimbursement Plan is intended for emergency purposes (for example traveling away from home) or other emergency situations.
Claim forms may be obtained from the Administrative Office. One portion of the claim form is to be completed by you, the other by the pharmacy. Claim forms must be filed within 15 months of the date of the drug charge to be eligible for reimbursement. Completed claim forms may be mailed to the following address:
1144 Lake Street - 4th Floor
Oak Park, IL 60301
Claims will generally be processed within 30 days from the date the claim is received by Citizens Rx.