Costco Health Solutions offers the services of a pharmacy benefit manager. We provide cost-effective prescription drug benefits for our clients and their members. Our mission is to provide the best value at the lowest price possible.

A pharmacy benefit manager (PBM) processes and pays prescription drug claims for its members. It contracts with pharmacies and builds and maintains drug formularies. A PBM also negotiates discounts and rebates from drug manufactures.

Most often you will be able to continue to use your current pharmacy. There are more than 65,000 pharmacies in the Costco Health Solution network. To ensure the best savings not only to you but to your plan we encourage you to utilize a Costco pharmacies (do not need to be a member to use the Costco pharmacy).

A complete list of pharmacies is available on the home page under pharmacy locator. If the pharmacy you currently use is not listed, please contact Costco Health Solutions customer care toll-free number listed on your pharmacy benefit member ID card to confirm whether your current pharmacy is participating with Costco Health Solutions.

Your Formulary ( preferred drug list) is available on the home page under the Member Services Tab. The coverage associated with each drug is noted on the formulary. Also included is information regarding which drug products are subject to prior authorization and / or quantity limits. The formulary does not specifically indicate the dollar amount members can expect to pay for each drug product. The formulary document does not list every covered medication. See your Schedule Benefits for more information.

Yes, some medications do require prior authorization. More information about which drugs require prior authorization is available you’re the formulary tab. On the formulary, medications that require prior authorization for coverage are marked with “PA” next to the medication. Your physician submits the prior authorization request on your behalf. Costco Health Solutions will review the prior authorization request within 48 hours of receiving complete information from your physician.

Drugs listed on the formulary with a label of “PA” require prior authorization before the drug will be covered by the plan. A label “ST” means the drug falls under the step therapy program. Usually, this means that you may need to first try a safe and more cost-effective drug before moving to a more costly treatment. A “QL” label identifies drugs that have quantity limits applied. For more information, please contact Costco Health Solutions Customer Care toll-free at 1-877-908-6024.

A generic drug is a drug that is the same as a brand name drug in dosage, safety and strength. It is also the same in how it is taken, how it works in the body, quality, performance and intended use. Typically, generic drugs are less expensive than their brand counterparts. They can save you money by reducing copays or—in the case of over-the-counter drugs—by allowing less out-of-pocket expense at the cash register.

If you are traveling and require the dispensing of covered drugs, the following policy applies:
If traveling for less than one month:

• Any participating pharmacy can arrange for an additional one-month supply to be taken with you. A copayment or coinsurance will apply for each month’s supply.

If traveling for more than one month, but within the United States:

• You can request the participating pharmacy located in the area where you will be traveling to request your current pharmacy to transfer your prescription order.

A member can make a request for reimbursement by completing the Direct Member Reimbursement Form. You will be reimbursed directly for covered services up to the Costco Health Solutions contracted amount. All requests for member reimbursement should be directed to the following address:

Costco Health Solutions
P.O. Box 999
Appleton, WI 54912-0999
Or
Fax form to: (920)735-5315/ Toll Free (855)668-8550

Please contact Customer Care toll-free at the number listed on your pharmacy benefit member ID card for questions about your pharmacy benefit.

24 hours a day, 7 days a week (closed Thanksgiving and Christmas Day)