Benefits is a tool which allows you, as a beneficiary, to access information related to your pharmacy benefits on a simple way and from the comfort of your home.

Benefits provides information pertaining the coverage status, pharmacy claims or the medication formulary, among others.

There are several reasons for being unable to sign up.

  1. You might not be active within the plan. If you believe that this is not true contact your plan customer service number located in the back of your medical insurance card.
  2. You might be submitting the wrong password. If this is the correct password write to us in the Contact Us section.
  3. You might be submitting the wrong email. If this is the correct email write to us in the Contact Us section.

Once you have signed into Benefits, you can view your account information via accessing the My Account option located at the top right corner of the page (the option appears when your run the mouse over your name).

Yes, you may change your password at any time. You just need to sign into Benefits, access the My Account option located at the top right corner of the page (the option appears when your run the mouse over your name) and select the Change Password tab. You must then submit all the required fields.

First you need to sign in to Benefits, access the My Account option located at the top right corner of the page (the option appears when your run the mouse over your name) and select the Notifications tab. There you must select which method of communication you preferred and the type of alert you wish to receive.

Yes you can! Go to the My RxHome section and you can see how much you have spent under the My Drug Coverage up to area.

Once you have signed in, you can hover over your name at the top of the website browser and find all dependents under 18 at the "switch account" section. You can switch between accounts to see their information.

The My Meds section displays the detail of the drugs that you are currently consuming, including information on the claim and drug, and the drug utilization history. This page provides the option to search by a date period, sort by different parameters and even download the results in pdf format.

The My Meds lists displays all the claims of the drugs that you are currently consuming, including information related to the claims:

  • date of next refill (if available),
  • how well you’re complying with your drug therapy (in case of a maintenance drug),
  • which physician prescribed the drug,
  • available generic, if any,
  • pharmacy where you bought the drug,
  • how much you should had paid, and
  • a link to additional information of the drug.
Once you select a drug from the My Meds list, on the Claims History list below all past claims of the selected drug will be displayed.
The My Meds list provides a visual aid using a red flag icon next to a drug to warn you when a refill at the pharmacy has expired because you didn’t pick it up on time. This icon helps you identify gaps in your therapy which you should avoid.
The "How am I doing?" column in the My Meds list uses a ranking of 1 (very poor) to 5 (very good) stars to show you how well you are maintaining drug therapy adherence to each of the drugs that you’re currently consuming.
The "On Time?" column on the Claims History list shows if you picked up a past claim on time based on when your refill was due.

The Find a Pharmacy section provides a tool to search for a list of pharmacies near a specific location or to search for a particular pharmacy within your plan’s network.

To search for a list of pharmacies near a location, select the Near me tab. Enter an address and the miles radius in which you want to search for pharmacies. A list of pharmacies in your plan’s network, within the selected radius of the entered address, will appear.

To search for a specific pharmacy select the By Location tab. You can perform a pharmacy search using the following search criteria:

  • Pharmacy Name
  • Zip Code
  • City
  • State

You can also search by the type of pharmacy network, for example:

  • Preferred
  • Non-Preferred
  • Specialized
  • Mail Order
  • Drive-Thru
  • 24 hr. Pharmacies
  • Handicap

Based on the search criteria entered the tool will present a list of pharmacies within your plan’s network.

The search results will present the address of the pharmacy, pharmacy schedule and the pharmacy phone number.

Yes. The pharmacy search tool allows you to search pharmacies in and out of Puerto Rico, meanwhile they are within your plan network.
If you don’t find a pharmacy, this pharmacy is not in your plan’s network and is considered an "Out of Network" pharmacy.
Utilizing the Save Money section you can determine if there is a generic substitution for a medication that you’re taking and is covered by your plan. These generic options could be more cost effective to you in comparison to the brand version. Ask your physician if any of the brand-name medications that you are currently taking can be filled with a generic alternative. Once you begin using generic drugs you can start to reduce prescription drug costs while maintaining the same strength, dosage and quality as the brand-name drug.
On the Shop Smart option you can compare the cost of your medications among pharmacies near your location. This will help you identify savings opportunities just by changing the pharmacy from which you’re obtaining your medication.
Pharmacies may offer better prices if you buy larger amount of day supplies. Here you will find an estimate of how much you may save if you get your maintenance drug prescriptions for ninety (90) day supplies.
On the Mail Order option you can compare your medications costs at the pharmacy you’re currently using against obtaining it from Mail Order. You will also be able to see a savings estimate if you start using Mail Order services.
Yes you can! You can select the Discover how link provided in the Mail Order section or download the Mail Order

On the My RxBenefits section you can perform or get the following:

  • inquire to validate if a drug is covered by your plan,
  • download a copy of your plan’s drugs list (formulary),
  • validate how much drug cost you have accumulated, how much drug cost the plan has paid and how much copayment you have paid in order to learn in which phase of the benefit you’re currently in, and
  • review your plan’s drug copayments.
In the RxBenefits section, once you have searched a drug by name in the What medications are covered by my plan? area, the tool provides the tier where the drugs is. Using this tier information you can estimate your costs by comparing the drug tier number to the copayment information located in the What are my costs? area.
If you have doubts regarding your copayments, you may call 787-555-1234 or use our Co-Pay Estimator.
Select the How tiers are defined? link on the What are my cost area?. This link will provide detail information on the type of drugs that are included on each drug tier.

RxPedia is a medication search engine. It displays related drug information and how to use it, for example:

  • patient education,
  • recommended dosage and administration according to age,
  • indications and usage,
  • contraindications,
  • side effects,
  • drug-to-drug interactions,
  • medical conditions reference,
  • equivalent drugs,
  • Warnings and cautions,
  • how the drug is supplied,
  • storage and handling, among others.

The My Plan Documents section allows you to access important documents related to your plan, for example:

  • Explanation of Benefits document
  • drugs lists (formularies),
  • reimbursement forms,
  • mail order brochure and forms,
  • Prior Authorization request form, and
  • coverage certification.

You can request a Prior Authorization or Exception in two ways:

  • Under the Forms tab you can access the Prior Authorization form which you can be downloaded into your computer and sent to the fax number in your form.
  • Another method is requesting it online. To request a Prior Authorization or Exception online you must select the Prior Authorization/Exception Online link. When selected this will redirect you to the online form.

To obtain your Coverage Certification you can use the Coverage Certification link located at the bottom of the My Plan Documents section.

  • To download the English version select the link Print Coverage Certification (English).
  • To download the Spanish version select the link Print Coverage Certification (Spanish).

To access the Reimbursement Form you must select the Forms tab and then select the Direct Members Reimbursement option. After the document has loaded you may print or download it to your computer.

Yes you can! You must access the Forms tab and select the Drug Formulary option. This document contains the list of drugs covered by your plan.

You can enlarge the document preview. Select the Fulltool expansion icon on the upper right side of the preview window. This icon looks like a circle with two arrows. After you select it the document preview will enlarge. 

If you wish to return to the smaller document preview, reselect the Fulltool option and the document will return to its original size.

The Co-Pay estimator will allow you to obtain an approximation of the amount that you will pay for your prescribed medication. It has a series of fields to help you narrow down your search. It contains a Medication field in which you can submit the name of your medication. There’s a Pharmacy field that allows you to specify a pharmacy. The Quantity Dispensed field allows you to submit the amount of medication that you were prescribed. The How many Days fields allows you to submit how long you will be taking your medication. Just remember that this tool only provides an estimate!

The My Conditions tools is design to help you understand the importance of complying with your therapies as prescribed by your doctor. 

This tool will display for certain chronic conditions, how diligent and adherent you are with your prescriptions and refills. This information will help you evaluate how well you’re following your doctor’s prescriptions. 
Some of the chronic conditions that Benefits measures are:

  • diabetes,
  • hypertension,
  • colesterol,
  • HIV

The My Conditions section presents a summary of all your chronic conditions and a visual status of your therapy adherence using a scale from 1(Very Poor) to 5(Excellent) stars. 

In addition to the summary of your conditions, My Conditions provides links for you to see all claims related to each one of your chronic conditions.