It’s a service that allows you to order and receive your prescription drugs by mail. Triple-S Advantage offers its mail-order pharmacy service through Walgreens Mail Service. You can read more about it here (link to external page).

You or your physician could request an exception to have the plan cover your medication. If your physician says there are medical reasons to justify an exception, he/she can help you request an exception to the rule.

You can request different kinds of exceptions:

• If your prescription has a quantity limit, you may ask us to disregard this limit and extend our coverage.
• You may ask us to increase the level of coverage for your medication. This would reduce your copay.
• If your medication requires you to first use another medication, you may ask us to disregard the step-therapy requirement.

As a rule, we will only approve exception requests if a lower dosage or the prescription alternatives included in the plan’s Drug List would not be as effective to treat your condition and/or could result in adverse medical effects.

If we do approve your exception request, this approval will be valid for the remaining policy year, as long as your physician continues prescribing the medication and it continues being secure and effective to treat your condition. If we deny your request, you may appeal our determination. Please refer to your Evidence of Coverage for more information about filing appeals.

You can read more about it here (link to external page).

If your medication is not included in the Drug List you have at home, please check the updated Drug List available on your plan’s webpage (see column to the right). This list is updated on a monthly basis. You may also contact Member Services to check if the medication is covered. If Member Services confirms we de not cover your medication, you have two options:

• You could ask your physician to change your prescription to one that is covered by us.
• You or your physician could request an exception (a type of coverage determination) to have your medication covered.

You can fill out maintenance drug prescriptions at a preferred pharmacy, or you can request our mail-order pharmacy service. Maintenance drugs are identified as MO in the drug list, under the abbreviation descriptions and in the Requirements/Limits column.