Questions Regarding Prescription Drug / Medco Information
Unable to find the answer you are looking for?
You may want to try a different FAQ topic or ask us through our
general questions form. If you have a question pertaining to Customer Service, please email a Customer Service Representative directly via My Health Plan.
Please Note: Only Customer Service is able to answer specific coverage questions via email.
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How do I know if I have prescription drug benefits?
Check your Medical Mutual ID Card. You have this benefit if you see the Medco precriptions logo and a Medco group number located on the front of your ID card in the lower right hand corner.
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I have several maintenance prescriptions that I need to order. How can I order them?
You can order maintenance prescriptions either online through Medco or via the mail by filling out Medco's prescription order form.
To order online through Medco, you must register online. If you have not yet registered for Medco, you can do so by following the registration link on our /member/account/pharmacy.aspxMedco page.
If you prefer to utilize the mail-in form, you can print out a copy of the form from the /member/account/pharmacy.aspxMedco section of the Medical Mutual Web site.
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When should I call Medco customer service versus Medical Mutual customer service?
If you have a Major Medical prescription drug benefit:
Medco customer service should be contacted for Home Delivery inquiries, automated pharmacy locator information, and to obtain a copy of either the voluntary formulary guide, the major medical prescription drug member guide, or a mail order envelope.
Medical Mutual customer service should be contacted for any claim status questions, benefit inquiries, or for major medical claim forms for non-participating pharmacies. You can also access most of this information through My Health Plan, the Member’s section of this Web site.
If you have a retail prescription drug co-payment and/or a Home Delivery prescription drug co-payment, i.e. $5.00, $10.00, etc:
Medco customer service should be contacted for benefit inquiries, Home Delivery inquiries, automated pharmacy locator information, and to obtain a copy of either the retail prescription program guide, mail service program guide, voluntary formulary guide, or a mail order envelope.
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What is Medco?
Medco serves as the Pharmacy Benefits Manager (PBM) for Medical Mutual, and administers all prescription drug programs for Medical Mutual. Medco is the largest PBM in the nation with approximately 2,300 Ohio and over 50,000 retail pharmacies nationwide. Medco operates its retail drug store prescription program under the name Medco Prescriptions, and its Home Delivery Pharmacy Service™ under the name Medco Health Solutions, Inc. Medco offers you the following services:
- Low, preferred, prescription drug prices
- An extensive network of retail pharmacies participating in its Medco Health Prescriptions program.
- The convenience of Medco Health Home Delivery Pharmacy Service™ for those who have this option as part of their insurance plan. This program is beneficial for those on maintenance medications for chronic conditions because up to a 90-day supply of medication can be obtained.
For assistance in finding a Medco Prescriptions network drug store near you, or for a list of preferred drugs & other drug information, please visit the Medco Web site.
To review the list of preferred drugs please visit the Medco Web site.
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Will I be required to pay for my prescription drugs under the Medco program?
If you have major medical coverage that INCLUDES a small co-payment at the time of purchase:
At a Medco prescriptions participating pharmacy:
Present your Medical Mutual ID card to the pharmacist, and pay the co-payment for your prescription.
At a non-network pharmacy:
You must pay the full amount of the prescription, complete a claim form, and attach your detailed prescription receipts. Please send the claim form and receipts to the address identified on the form. You will be reimbursed according to the benefit provisions detailed in your prescription drug plan.
If you have major medical coverage that does NOT include a small co-payment at the time of purchase:
At a Medco prescriptions participating pharmacy:
Present your Medical Mutual ID to the pharmacist and pay 100 percent of the Medco preferred price when picking up your prescription. The pharmacist will automatically submit your claim for you. You will then receive payment from Medical Mutual according to your benefit provisions.
At a non-network pharmacy:
Pay the drugstore's submitted charge and submit a completed claim form along with a detailed pharmacy receipt to:
Medical Mutual of Ohio
PO Box 91478
Cleveland, Ohio, 44101-3487.
Your reimbursement will be based on your benefit provisions and you will receive payment from Medical Mutual. You can find claim forms through the member’s section of the Medical Mutual Web site.