Whom do I call concerning my prescriptions?
Magellan Rx Management is the administrator for GatorCare’s pharmacy benefits. The GatorCare dedicated toll-free number is (800) 651-8921.
The prescription plan has 5 tiers of coinsurance. How can I find out the tier for the medication being prescribed?
Magellan Rx Management has introduced a new look-up tool for our GatorCare members. The tool is user friendly and offers useful and important information. After navigating to this page, enter the name of the drug on the left hand side. After several seconds, possible matches appear on the right side of the screen. The tier to which the drug is offered through the GatorCare formulary is found along with other alternative drugs and information. By clicking on the ‘find alternative drugs’ link, a member can determine if an alternative medication for the drug may be available on the formulary on a lower tier, reducing the member’s out-of-pocket expenses.
How can I find out the expected cost for a prescription?
Members should establish an account on the MagellanRx portal. Once the account has been set up, there is a “Price a Drug” function. Members can also contact the GatorCare dedicated line at Magellan Rx Management at 1-800-651-8921. If the call is being made prior to the effective date of coverage, please advise the GatorCare customer representative that your policy is still not active, but you expect it to begin at a later date.
What is a pharmacy deductible?
GatorCare members are required to satisfy a prescription drug deductible for purchases of all Tier 2-5 prescription drugs before the plan’s prescription benefits apply. The deductible amount is $100 per covered person, with a deductible cap of $400 per family. Each member will pay the deductible plus any applicable coinsurance, up to the cost of the drug. For drugs that cost less than $100, members will pay the cost of the drug, until the $100 prescription drug deductible is met. The deductible applies regardless of whether you purchase your prescription from a retail or mail order pharmacy. For more information, visit gatorcare.org/pharmacy. *Pharmacy deductible does not apply to Healthy Rewards HSA plans.
Are the Shands pharmacies considered in-network?
The Shands Pharmacies in Gainesville are in-network and offer GatorCare members a discount on prescriptions.
UF Health Pharmacy – Shands Cancer Hospital
1515 SW Archer Road Gainesville, FL 32608
Main Phone: 733-0890 Fax: (352) 733-1291
Hours: Monday – Friday: 8:30 a.m. – 7:00 p.m.
Located next to the Adult Emergency Department and behind the Opus Café in the UF Health Shands Cancer Hospital.
UF Health Pharmacy – Shands Hospital
1600 SW Archer Road Gainesville, FL 32608
Main Phone: (352) 265-0405 Fax: 265-0133
Hours: Monday – Friday: 7:00 a.m. – 7:00 p.m. Saturday, Sunday and holidays: 9:00 a.m. – 1:00 p.m.
Located next to the UF Health Shands Hospital Atrium behind Opus Café.
UF Health Pharmacy – Medical Plaza
2000 SW Archer Road Gainesville, FL 32608
Main Phone: (352) 265-8270 Fax: 265-8276
Hours: Monday – Friday: 8:30 a.m. – 5:00 p.m.
UF Health Pharmacy – Springhill
4197 NW 86th Terrace #1131, Gainesville, FL 32606
Main Phone: (352) 733-0090 Fax: 733-0098
Hours: Monday – Friday: 8:30 a.m. – 5:00 p.m.
Are there other pharmacies that are considered in-network?
The Magellan Rx Management network includes more than 60,000 retail pharmacies. All major chains are included (Shands, Walgreens, CVS, Publix, Winn Dixie, Target, Kroger, etc.). Members can verify if a pharmacy is in-network on the Magellan website or by calling customer service at 800-651-8921.
Am I required to use the Shands Gainesville Pharmacy?
All members are encouraged to use the Shands Pharmacies. The Shands Pharmacies offer GatorCare members a discount when filling preferred medications. In certain cases of specialty medications, GatorCare members from the Shands Healthcare organization may be required to fill specialty medications through the Shands Pharmacy. Magellan Rx Management should be contacted at (800) 651-8921 in the event a member has a question about pharmacies in the network.
Am I required to use a mail- order service for my maintenance drugs?
Members are not required to use mail order service, but it is encouraged. Members can fill their Tier 1, Tier 2, or Tier 4 maintenance medications at retail in a 90-day supply for the same mail order coinsurance if they choose. (Some restrictions apply to controlled medications.) *Note: Beginning 8/16/2017 for the GatorGradCare plan and 1/1/2018 for other plans, all Tier 1 and Tier 2 maintenance medications must be filled at a 90-day prescription, after filling up to two 30-day fills. The list of maintenance medications can be found here.
How do I order 90-day mail order prescriptions?
All members, excepts the Shands Healthcare members in Gainesville, can order through Walgreens Mail Order at (800) 999-2655 or www.walgreens.com. All members can also contact the Shands Medical Plaza Pharmacy at (888) 345-8270 or (352) 265-8270, and ask for a 90-day supply. Orders can either be picked up or delivered free of charge to the members’ address. Shands Healthcare employees and dependents are required to use the Shands pharmacies for mail order services.
If I currently order 90-day prescriptions through my prior carrier, will the refills transfer? What do I need to do to get this done?
As long as there are refills available, and the medication is not a controlled substance, the prescription can be transferred from one pharmacy to another. In order to have remaining 90-day refills transferred to Walgreen’s Mail Order, non-UF Health Shands members may call (800) 999-2655 and a representative will assist in having the prescriptions transferred and filled; UF Health Shands members may contact the Shands Medical Plan Pharmacy at (888) 345-8270 or (352) 265-8270 and request assistance in having the prescriptions transferred and filled through the Shands Pharmacy.
If my physician prescribes a medication that has a generic equivalent, will the plan allow me to have the prescription filled as written and not require me to accept the generic?
The pharmacy benefits permit a member to have the prescription filled as written, but the member is required to pay the brand copay plus the difference in cost between the brand and generic if you choose a brand product when a generic equivalent is available.
If I am allergic to a generic or if my physician has determined that I cannot take a generic drug, what process must I follow to receive an exception?
To request an exception, an appeal with clinical documentation must be submitted to Magellan Rx Management .
I am a new member. What is required to have a prescription filled or refilled at the pharmacy I’ve been using for years?
The GatorCare ID card includes pharmacy information. To have a prescription filled or refilled at retail pharmacies or through mail order, please provide your updated prescription information found on the ID card. This new information is required by the pharmacy; otherwise, your request to have a prescription filled will be rejected. Many pharmacies use SSN’s thinking that is a valid default, and in the case of GatorCare, it is not. The member must provide the new ID. For more information, please contact Magellan Rx Management at 1- 800-651-8921.
I need to have a prescription filled and I do not have my new ID card. What should I do?
If you need a prescription filled and have not received your GatorCare ID card, please contact Florida Blue. There are two on-site representatives to assist you, or you can call the toll free number.
- Kelley Thomas – Florida Blue On-Site Representative in Jacksonville 904-244-9130
- Kelly Maloney – Florida Blue On-site Representative in Gainesville 352-594-3354
- Florida Blue GatorCare Customer Service – 1-800-664-5295
What is the process to have a prescription filled that requires a prior authorization?
If a Prior Authorization is required for your medication, provide your prescriber with the prior authorization form located here or have them call 1-800-651-8921 to request your prior authorization as soon as possible. Magellan Rx Management will notify you and your prescriber if the prior authorization is approved or denied. If approved, your medication will be covered at the appropriate co-payment or co-insurance under your plan. If denied, you can either purchase the drug for the full price or discuss alternatives with your doctor.