Address:

Community Care
1555 South Layton Boulevard
Milwaukee , WI 53215

Please contact us Monday through Friday 8:00 AM to 4:30 PM

For information, call (414) 385-6600 or
Toll-Free 1 (866) 992-6600
or TTY (414) 385-6626.

Para la información, llame (414) 385-6600. 

We provide interpreter services free of charge. If you need an interpreter to explain any service or benefit, call (414) 385-6600. 

Enrollment

To enroll in Community Care, contact our helpful enrollment specialists at (414) 385-6600. Our specialists will assist you throughout the enrollment process. For enrollment information, click here.

Service Area

Health, social and personal services (including prescriptions) are available through our Wisconsin Partnership locations. Click here for list of Community Care Partnership locations. You may also receive prescription medications from selected retail pharmacies in the area.

Community Care has contracts with pharmacies that equal or exceed CMS’ requirements for pharmacy access in your area. Click here to view the pharmacy directory.

Out-of-Network coverage

The following are a few exceptions when we will pay for a prescription filled at a pharmacy outside of our network.

Getting coverage when you travel or are away from the plan’s service area

If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need. You may be able to order your prescription drugs ahead of time.

If you are traveling within the United States and territories and become ill, lose or run out of your prescription drugs we will cover prescriptions that are filled at an out-of- network pharmacy. In this situation, you will have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. To learn how to submit a paper claim, please refer to the paper claims process described later.

You can also call Customer Service to find out if there is a network pharmacy in the area where you are traveling. If there are no network pharmacies in that area, Customer Service may be able to make arrangements for you to get your prescriptions from an out-of-network pharmacy.

We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency.

What if I need a prescription because of a medical emergency or because I need urgent care?

We will cover prescriptions that are filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgent care. In this situation, you will have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form. To learn how to submit a paper claim, please refer to the paper claims process described later.

Other times you can get your prescription covered if you go to an out-of-network pharmacy.

We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:

• If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24-hour service.
• If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail order pharmacy (including high cost and unique drugs).

In this situation, you will have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form.

Benefits

Community Care’s Prescription Drug Plan provides Wisconsin Partnership participants with full access to prescription drugs, in accordance with Medicare and Medicaid policies. Click here to view the Summary of Benefits.

Use the links below for detailed information related to our prescription drug benefit:

Medication Information

The medications that are ordered for you are on a list known as a formulary.  Community Care’s Formulary is designed to provide medications for virtually all illnesses the elderly may experience.  If you would like to see our Formulary, click here.

Some medications are not on our Formulary.  If you are currently taking a medication not on our Formulary, you have the right to request an exception in order for this medication be further evaluated for your personal use.  Requests for an exception will be reviewed within 3 business days.  Community Care will grant an exception when it determines that such a medication is medically necessary based upon several factors. If you would like to see our Exception and Appeals page please, click here.

There are utilization tools that accompany our Formulary, known as Prior Authorizations, Step Therapy Files, Therapeutic Interchange, Quantity Limits, and Generic Substitution.  To get further descriptions, please click here.

Community Care pharmacists will review your medications twice annually.  You may qualify for additional medication review if you have certain conditions and numbers of medications.  This additional review is known as the Medication Therapy Management Program.  To see this program, please click here.