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Reimbursement for medicine

There may be times when you pay for your medicine. Keystone First may reimburse you, or pay you back.

Generally, reimbursement is NOT made for medicines that:

  • Need prior authorization
  • Are not covered by either Keystone First or the Pennsylvania Medical Assistance program
  • Are not medically necessary
  • Go over certain dose and supply limits set by the FDA
  • Are re-filled too soon

You cannot be reimbursed if:

  • You were not eligible for pharmacy benefits when you paid for the medicine
  • You were not a Keystone First member when you got the medicine filled

To ask for reimbursement of medicines you paid for:

You must ask for the reimbursement in writing.* You must send a detailed receipt from the pharmacy that includes:

  • Date you bought the medicine
  • Member’s name
  • Drug store name, address (city, state, zip code) and phone number
  • Name, strength and amount of medicine
  • NDC number of medicine (if you are not sure about this information, ask the pharmacist to help you)
  • Total amount you paid for each medicine

Write your name, address, phone number, and Keystone First ID number on your receipt or another piece of paper.

Send the above information to:

Pharmacy Reimbursement Department
Keystone First
P.O. Box 336
Essington, PA 19029

It may take 6 to 8 weeks before you get your payment.

NOTE: A receipt that does not have all of the above information will NOT be reimbursed and will be returned to you. Receipts should be sent to Keystone First as soon as possible. Receipts older than 365 days will not be accepted. Please remember to keep a copy of the receipt for your records.

* If you need help writing this request, please call Member Services.