ERACPeople - Prescription Drugs Question and Answers

Prescription Drug Questions

How do I use the Express Scripts home delivery program?
Complete the Home Delivery Form by providing the required member and payment information, attach your original written prescription(s) and mail to the address on the form. Members can expect to receive their first home delivery prescription(s) within 14 days of the date the prescription was mailed to Express Scripts. Alternatively, you can print the Fax Order Form, take it to your doctor and have your doctor fax your prescriptions directly to Express Scripts.

You may request forms and envelopes for the home delivery through your local human resources personnel or by calling Express Scripts customer service at 1-866-291-2607.

Are oral contraceptives covered under the prescription drug plan?
Yes! Order a 90-day supply by home delivery and SAVE! because you pay just one copay. Or, pick up a 30-day supply from your local pharmacy.

How can a covered dependent get more than a one month supply of medication if they are going on vacation?
There are two ways to do this: 1) If this is an ongoing prescription, the easiest way is to fill the prescription by home delivery; or 2) The employee can complete a Claim Problem Resolution Request Form explaining why the prescription needs to be filled and include the name, address and phone number of the pharmacy being used, the drug name, dependents name, along with the employee's name and social security number. Corporate Benefits will request Express Scripts authorize the pharmacy to fill the prescription. This process takes at least 24 hours, so employees should not wait until the last minute before making the request.

I am going to be at a temporary address while on vacation or away at school. Can my prescription be sent to me there?
Yes. Prescriptions may be sent to a temporary address if you will be at that address for at least 14 business days. Please call Express Scripts customer service at 1-866-291-2607 to have an associate set up your temporary address. Please note that if you are traveling out of the country you may not be able to receive a shipment of prescription medications by home delivery, and you may need to make arrangements to receive your medications prior to leaving the country.

I lost my prescriptions due to a natural disaster, or I have lost part of a prescription and it is too soon to get it refilled. How can I get them filled?
Please contact your doctor for an immediate supply to be filled at a network pharmacy. You will also need to call Express Scripts customer service at 1-866-291-2607 and advise them of the situation. They will request a one-time replacement on your prescription(s). If you have lost a portion of a prescription you may call Express Scripts customer service at 1-866-291-2607 and an associate may be able to request a one-time replacement of the pills you lost.

How does filling prescriptions by using home delivery save me money?
The home delivery service allows you to order a 90-day supply of maintenance prescription drugs for a copay equivalent to a 60-day supply at a retail network pharmacy. Filling the same prescription at a retail network pharmacy would require three 30-day supplies and three copays. Plus, all home delivery prescriptions are mailed directly to your home at no charge.

Can I have my prescriptions sent overnight?
Express Scripts will generally ship prescriptions via the US Mail service, and you should allow 14 days for your request to be processed and prescription mailed to you. There are other options available upon your request, which will require an additional shipping charge.

What happens if I send in multiple prescriptions and one or more drugs are on back order?
Express Scripts' written policy states that they will hold the order for up to two days in an exception area or five days total time before taking any action. If only one prescription is involved, they will return the prescription to you with a letter of explanation. If more than one prescription is involved, they will split the order and fill what they can and return the prescription for the back ordered drug as described above.

I have a prescription already on file at my local pharmacy, and would like to receive my prescription through home delivery. Can Express Scripts accept a transferred prescription over the phone?
No, Express Scripts' home delivery pharmacies are required to maintain the original prescription on file for their records. A member wishing to have a prescription filled via home delivery will need to obtain a new written prescription from their doctor and follow the home delivery procedures.

Are speciality medications covered under our pharmacy plan?
Yes, medications such as those used to treat conditions such as multiple sclerosis, Rheumatoid arthritis, HIV/AIDS, cancer, hepatitis B&C, hemophilia, and growth hormone deficiency arecovered through Express Scripts’ specialty pharmacy, CuraScript. You pay a 20 percent copay with a maximum out-of-pocket of $150 per prescription. Your annual maximum out-of-pocket for specialty medications will be $2,000 per member and $4,000 per family. The maximum days supply for specialty medications is 30 days. To contact Express Scripts’ specialty pharmacy call 866-848-9870.

How do I start using CuraScript specialty pharmacy for my specialty medications?
Call CuraScript specialty pharmacy at 866-848-9870 and provide them with your name, ID number, delivery address, daytime phone number, physician's name and phone number, medications and supplies needed, and date drug is needed.

How do I order injection supplies?
The supplies you need to administer your injectable medication are included at the time your drug is delivered, at no additional cost. If you have run out of supplies for your injectable medication, call CuraScript specialty pharmacy at 866-848-9870, tell them the supplies you need, and the pharmacy will send them to you.

How do I refill my prescriptions with CuraScript specialty pharmacy?
The CuraScript specialty pharmacy team will call you approximately 3 weeks after your order is sent to see if you are ready to order your refill. If you need to change your schedule, call CuraScript specialty pharmacy at 866-848-9870, and tell them when you will need the refill. A member of the CuraScript specialty pharmacy team will contact you 24 hours prior to the delivery date to confirm your order.

What if my doctor changes the dosage or frequency of administration of my specialty medications?
If your doctor changes your prescription for specialty medication, call CuraScript specialty pharmacy at 866-848-9870. A CuraScript specialty pharmacy pharmacist will contact your doctor and request a new prescription for your medication change.

I/my dependents receive a controlled medication. Can we still use home delivery?
Yes, controlled medications are available through the home delivery pharmacy. The laws regulating the dispensing of controlled medications vary from state to state. Home delivery prescriptions are subject to dispensing laws where your home delivery facility is located even though the prescribing doctor wrote the prescription in another state. State controlled substance law limits the dispensing of Schedule II medications to a maximum of 30-day supply. A new written prescription is required for each dispensing and refills are not permitted. However, in certain circumstances, a prescription for such drugs may be dispensed for more than a 30-day supply, if the physician writes the diagnosis of the patient on the face of each prescription submitted. The maximum quantity Express Scripts is allowed to dispense even with the diagnosis, is a 90-day supply.

By law, Express Scripts is restricted from accepting prescriptions for controlled medications via fax from the doctor's office. Please mail in an original prescription.
Controlled medications require a signature and a street address for delivery. We are unable to deliver to a PO Box.

Why did I receive a generic prescription through the home delivery program, when my doctor wrote the prescription for a brand drug?
If your physician writes the prescription allowing for substitution, you will automatically receive a generic drug. If the prescription is not signed to allow substitution and a generic exists, Express Scripts' home delivery pharmacist will contact the physician to ask if a generic substitution is OK. If your physician allows the generic prescription, you will receive the generic drug and a letter will be sent to you explaining the change and that it was approved by your doctor.

Are vitamins covered under the pharmacy plan?
Vitamins - except for pre-natal vitamins with a prescription - are NOT covered under the pharmacy plan.

How do I get a prescription drug covered that is not covered under our plan?
Employees may petition Express Scripts to allow coverage of a non-covered drug by obtaining a letter of "medical necessity" from their doctor. You or your doctor can fax this letter to Express Scripts at 800-357-9577. Upon receipt, Express Scripts will review and respond usually within 48 hours. Your doctor may call 800-417-8164 with questions regarding prior authorization or to expedite the process.

How can I find out if my pharmacy is in the Express Scripts pharmacy network?
When you enroll, you will receive a packet of information from Express Scripts, which includes a listing of the participating pharmacy chains by state. You can also visit the Express Scripts web site to locate a participating pharmacy near you, or you can call customer service at 1-866-291-2607.

What if I need to fill a prescription in an emergency and a network pharmacy is not available?
In an emergency or when no other options are available, you can fill a prescription at a pharmacy that does not participate in the plan. In this case, you will pay for the full amount of the prescription up-front and will be reimbursed the same amount as if you went in-network - once a completed claim form (PDF) and receipt is mailed to Express Scripts.

How do I get a new I.D. card?
Contact your local HR Department to request a new I.D. Card.

What is a Formulary?
A formulary is a list of preferred drugs including drugs that are safe, clinically effective, and economical. A committee of pharmacists and physicians developed the Express Scripts formulary. This committee meets regularly to discuss new drugs and trends in therapy. These drugs have been demonstrated to be clinically effective and are also cost-effective to help manage prescription costs while continuing to maintain the quality of care. Savings are achieved through lower prescription costs by creating preference for the most cost-effective brand name and generic drugs.

What is the difference between a refill and a renewal?
A refill slip is made available to home delivery participants when the doctor has authorized refills on the original prescription. You may send in your refill slip to obtain another supply of the prescription.

A renewal slip is made available to home delivery participants when you have used all of your refills authorized on the original prescription. A pre-printed renewal slip is provided for you to take to your doctor to review for accuracy and place the adhesive sticker on the prescription blank and sign.

*If there is any change at all on the prescription including but not limited to: number of refills, strength or daily dosage, please have your doctor write a new prescription and discard the renewal slip.

The home delivery pharmacy phone system and patient information cards ask for the cardholder ID #. What is it and where do I find it?
Typically your cardholder ID # is the social security number or alternate ID number of the insured person in your family who carries the prescription benefits. If this is the first time you are using your prescription home delivery benefit please include the social security number of the person in your family who carries your prescription benefits. This will ensure that the Express Scripts pharmacy staff will be better able to identify your coverage and fill your prescriptions more efficiently. If you are calling for a refill, please have your cardholder ID # available for the call center associates to expedite the process.

What if I am allergic to the generic or my doctor would like me to receive the brand name prescription?
In general, generic prescriptions will be substituted for brand name prescriptions whenever available and permitted by your doctor and state pharmacy laws. If a brand name prescription is required or requested, it is necessary for your doctor to write the prescription as specified including, "DAW" (dispense as written) on the prescription. The home delivery pharmacy will then send the brand name prescription to you. * Please be aware that you will be charged for the difference in cost between the brand and generic versions of the prescription plus the generic copay, depending on your benefit plan design.