Pharmacy
Formulary
*The CampusCare Formulary is subject to changes throughout the semester without notice.
Pharmacy Benefits
Prescription Copays
Formulary Generic $20 copay
Formulary Brand $35 copay
Non-Formulary $60 copay
*unless under the exclusions listed in the Certificate of Coverage.
Members will be charged the prescription copay when picking up medications at an In-Network Pharmacy. Please show your CampusCare ID Card or I-Card when picking up prescriptions at In-Network Pharmacies.
Members may only be dispensed a sixty (60) day supply after the Enrollment Period deadline date and up to thirty (30) days prior to the last day of that Term. Ninety (90) day supplies are not covered.
Members will need to pay the full cost at Out-of-Network Pharmacies and submit a claim for reimbursement. See information below regarding external pharmacy options & reimbursement.
In-Network Pharmacy Locations
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Chicago
University Village Pharmacy
722 W. Maxwell St. 2nd Fl
Chicago, IL 60607
Ph: 312-355-2345
Monday-Friday 9:00 AM – 5 :00PMSCB Pharmacy
1009 S Wood Street Rm 1025
Chicago, IL 60612
Ph: 312-996-6540
Monday-Friday 9:00 AM – 5 :00PM
Saturday 9:00 AM – 1:00 PM -
Rockford
North Park Pharmacy
7924 North Second St.
Machesney Park, IL 61115
Ph: 815-633-3431
Monday-Friday 8:30 AM – 8:00 PM
Saturday 8:30 AM – 4:00 PM
Sunday 9:00 AM – 1:00 PMO’Brien & Dobbins Pharmacy
216 S. State St.
Belvidere, IL 61008
Ph: 815-544-3433
Monday-Friday 9:00M – 7:00 PM
Saturday 9:00 AM – 4:00 PM
Sunday 9:00 AM – 1:00 PMDowntown Discount Drugs
331 W. State St.
Rockford, IL 61101
Ph: 815-962-2166
Monday- Friday 9:00 AM – 5:00 PM
Saturday 9:30 AM – 12:00 PM
Sunday Closed -
Peoria
Preckshot Compounding Pharmacy
5832 Knoxville Ave Suite E
Peoria, IL 61614
Ph: 309-679-2047
Monday- Friday 9:00 AM – 6:00 PM
Saturday 9:00 AM – 3:00 PM
Out-of-Network Pharmacy Information
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Out-of-Network Pharmacy Benefits
Members also have access to any out-of-network pharmacy, such as Walgreens or CVS. Member must pay the amount in full upfront and mail in all original receipts, the pharmacy identification sheet, and a cover letter requesting reimbursement. Member is responsible for the prescription co-pay according to the CampusCare Formulary.
This applies to prescription medications ONLY (all non-formulary drugs must have an approval on file in order to be reimbursed). CampusCare only covers medical services, such as vaccines or urgent care, at a pharmacy if there is an authorized referral from the member’s primary care provider. CampusCare does not retroact referrals for services already rendered
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Out-of-Network Pharmacy Claims
External Pharmacy Reimbursement Requests should be mailed to:
CampusCare
P.O. Box 4313
Clinton, Iowa 52733Any further questions regarding your pharmacy claims and reimbursement requests should be directed to the Claims Department at 312-996-4915 option 2.
Formulary Exception Form
- If your provider prescribes a non-formulary drug, a Formulary generic or brand-name alternative should be considered first. To request a non-formulary drug, your provider must submit a medical necessity review to the Medical Director. The CampusCare Medical Director has the authority to deny the request if it is not deemed medically necessary. If denied, you can still fill the prescription, but CampusCare will not cover the cost, and you will be responsible for the full amount.
- The drug is excluded from coverage under the CampusCare Certificate of Coverage.
- At the recommendation of the treating provider, the Member has a medical necessity to remain on an excluded drug. Medical Necessity exist when a CampusCare Member is suffering from a health condition that may seriously jeopardize the Member’s life, health, or ability to regain maximum function. The Medical Director will review for clinical determination.