Magellan Rx Pharmacy Benefits
Group Number:  012967
Customer Service : 800-424-0472
COVID-19 AT HOME TEST REIMBURSEMENT PROCESS:
1. Review Process here
2. Complete Form
3. Submit
  • Access the member portal 
  • Print and complete the “Prescription Claim Form” Mail in the form and include the name of the OTC COVID-19 test, and a register receipt/proof of payment to the address below:
Magellan Health Services Attention:
Claims Department
11013 W. Broad Street, Suite 500
​Glen Allen, VA 23060

Fax: 1-888-656-3607

Prescription Drugs (In Network)* 

Retail (In-Network)
Up to 30 day supply 
Generic: 100% ($0 Copay) 
Formulary:  $25 Copay
Non-Formulary:  $50 Copay
Mail Order (In-Network)
​Up to 90 day supply
Generic:  $30 Copay
Formulary :  $50 Copay
Non-Formulary​:  $80 Copay
This web site is not a legal document.  This web site is not a guarantee of coverage, eligibility, or provider status and is designed for informational illustration only.  Benefits outlined on this web site are subject to change at any time.  Please consult your benefit plan provider(s) or administrator(s) for legal documents regarding your plan and to check coverage and/or eligibility.