A Healthy CollaborationSM

Prescription Drug Out-of-Network Coverage1

Community CCRxSM has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We will not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can use our Pharmacy Locator, or call Customer Services for an up-to-date list.

Formulary medicines may be covered in special circumstances, such as illness while traveling outside of the plan’s service area where there is no network pharmacy. You may pay more than the co-pay if you get your drugs at an out-of-network pharmacy.

For limits and your financial responsibility for access to drugs at out-of-network pharmacies, please see your Summary of Benefits.

1 Applies only to Medicare beneficiaries enrolled in plans with Medicare Part D Prescription Drug Coverage.

S5803_09P0008_v2 (07/2009) Last Updated: 06/23/2009

©2008 Universal American Corp. All rights reserved.