Pharmacy

Capstone Health Plan contracts with Partners Rx for pharmacy benefit management (PBM) services. Please review the links and documents provided under Resources on your right for additional information pertaining to pharmacy benefits for Capstone Members.

Where can I get my prescriptions filled?
Capstone offers a comprehensive network of pharmacies nationwide. Please view the Pharmacy Network Listing or you can use the pharmacy locator on the Partners Rx web site.

What if my prescription is for a medicine Capstone does not cover?
The pharmacy will ask the prescribing health care provider to consider ordering a similar medication that is on the Capstone formulary. If that is not possible or advisable, the requesting provider must send a medication prior authorization request describing why this particular medicine is needed. Please be sure your prescribing provider reviews the Capstone Drug Formulary before writing you a prescription and before going to the pharmacy.

Does Capstone cover over-the-counter medications?
Capstone covers many over the counter (OTC) medications. You must have a written prescription from your doctor for the OTC medication (non- prescription medications).

How do I get mail order medications?
After 3 months of filling the same prescription locally you will be asked to have this medication delivered through mail order. You can have a 90 day supply of medication delivered to your mailbox. To get started on mail order, please review the Pharmacy Mail Order instructions.

What if I have other insurance?
Capstone will pay your co-pays for you except if you have Medicare Part D (a Medicare Advantage plan), in which case Part D pays fully for most drugs. Capstone will only cover a limited number of medications that Medicare does not cover.

How can I be reimbursed for prescriptions I paid for?
Please complete and mail the Prescription Claim Form along with your prescription receipt(s) to Partners Rx. Requests must be submitted within 90 days of the date of the purchase to be eligible for reimbursement.

How do I get CRS and/or RBHA medications?
Medications that are prescribed by CRS or RBHA providers may not be filled through Capstone. When you go to your local pharmacy, please tell the pharmacist to bill CRS or your local behavioral health clinic. Please do not use your Capstone ID card to get these prescriptions.

What if I am going on vacation?
Please contact Member Services at 800-336-3874 for assistance.

Capstone Health Plan