Emergency Prescription Fills for Washington Members

How do I get an emergency prescription fill?

If you need to fill an urgent prescription that requires step-therapy or PacificSource’s preauthorization during nonbusiness hours, please visit an in-network pharmacy. A one-time override is called an “emergency fill” and can be done at an in-network pharmacy if the following conditions are met:

  • You are currently enrolled in a PacificSource group or individual and family health plan in Washington.
  • Waiting for the medication would result in imminent emergency care, hospital admission, or might seriously jeopardize your life or health or others who are in contact with you.
  • The medication is eligible for emergency refills. See the Washington Drug List (WDL) to see if your medication qualifies for an emergency fill. Look for an “EF” following the drug name.
  • You make the request through an in-network pharmacy
  • If you need more medication beyond the emergency fill, subsequent refills will need to be reviewed through PacificSource’s standard preauthorization process. 
  • The medication indication and dosage must be within FDA approved limits.

How much medication can I receive through an emergency fill?

You will receive:

  • No more than the prescribed amount up to a seven-day supply; or
  • The minimum packaging size available at the time the prescription is dispensed.

How much will the emergency prescription refill cost?

Cost sharing for an emergency fill that is dispensed for less than the standard refill amount will be prorated. The amount you owe will be calculated by finding the member cost-per-day for a standard refill and then multiplying the cost-per-day member by the number of days of the emergency fill. The deductible, if any, will still apply. 

InTouch for Members

Last updated 2/1/2019