Maintenance Medication Program 1. What is my Maintenance Medication Program?
Your Maintenance Medication Program provides you with an affordable way of obtaining maintenance medications. You can receive up to two fills of certain maintenance medications at your local pharmacy. You then have the choice to continue filling at the local pharmacy and paying 100% of the cost of the medication, or to use Home Delivery with the Express Scripts Pharmacy at your home delivery copayment.
2. What are the medications that are included in this program?
Maintenance medications are prescription drugs that you need to take regularly. Medications that treat ongoing conditions like high blood pressure, high cholesterol and asthma are usually considered maintenance medications. To find out if a specific drug is considered a maintenance medication by your plan sponsor, please call Express Scripts at 1-866-527-887.
3. What are the medications that are excluded from this program?
Common medications that are excluded from your maintenance medication program at this time include medications such as: • Nitrates (including, but not limited to Isosorbide DN, Nitrostat)
• Short-acting B2-agonists (including, but not limited to Proventil, Xopenex HFA)
• Apomorphine (including, but not limited to Apokyn)
• Medical and diagnostic supplies (including, but not limited to lancets & test strips)
• Non-sedating antihistamines (including, but not limited to Allegra, Clarinex)
• Medications to manage tuberculosis (including, but not limited to Myambutol, Isoniazid)
• Medications that are frequently titrated post-initiation/stabilization (including, but not
limited to digestive enzymes [Pancrecarb MS-16], phosphate binders [Renagel], Warfarin, Coumadin)
• Medications that manage sensitive indications (including, but not limited to antivirals
[Invirase], antineoplastics [Tamoxifen], antipsychotics [Invega], immunosuppressives [Rapamune])
• Tricyclic antidepressants (including, but not limited to Mirtazapine, Amitriptyline)
• ADHD medications (including, but not limited to Strattera, Adderall)
While these medications are not within your maintenance medication program, they may still be filled through the Express Scripts Pharmacy.
4. What are the benefits of this program?
There are four ways to benefit from this program:
5 Savings: Save money by ordering up to a 90-day supply of your medication.* 5 Safety: Pharmacists check every prescription for accuracy and potential drug
5 Service: Talk confidentially to a pharmacist 24-hours a day, every day. A patient care
advocate can connect you to a pharmacist at your request.
5 Convenience: Order refills easily online, by mail or phone with free standard shipping.
* This savings estimate is based on previous prescription-drug history. Estimates will vary depending on the drugs you are taking and your plan’s Home Delivery benefit.
5. How will I know which medications should be ordered through Home Delivery?
After you fill a maintenance medication under your maintenance medication program at a local pharmacy, you will receive a letter from Express Scripts explaining the benefit, identifying the prescriptions under this program and explaining the benefits of Home Delivery with Express Scripts. You will receive up to two letters per medication per year. Each letter will contain directions on how to move your prescription to the Express Scripts Pharmacy.
6. How do I order a prescription through my Maintenance Medication Program? (Home Delivery)
There are four ways to start using the Express Scripts Pharmacy:
Online • and follow the instructions to get started with Home
Delivery. There are no forms to mail, no doctor visits to schedule. Just submit your request online, and the Express Scripts Pharmacy will contact your doctor on your behalf for a new prescription.
By Mail • Ask your doctor to write a prescription for up to a 90-day supply of your medication (plus
refills for up to one year, if appropriate).
• Complete a Home Delivery order form. If you don’t have an order form, you can print
. Or, simply request an order form by calling 1-866-527-8878 and requesting one from a patient care advocate.
• Mail your order form and your prescription to the following address, which is also listed
Express Scripts P.O. Box 66583 City, State 63166
By Phone • Contact Express Scripts at 1-800-899-2125 and they can assist first time Home Delivery
users by setting up your Home Delivery profile and contacting your doctor on your behalf to obtain new 90-day prescriptions.
By Doctor Fax • After setting up your Home Delivery profile by web, phone or mail, your doctor can fax a
prescription for up to a 90-day supply of your medication (plus refills for up to one year, if appropriate) to the Express Scripts Pharmacy at 877-207-0438. Your doctor must include your name, date of birth, member ID number and mailing address.
7. Do I have to fill out a mail order profile form each time I send in a prescription?
No. It is only necessary to complete this form the first time you order medication, unless any information changes, such as mailing address or allergies. Please list all medications being taken so Express Scripts can review for potential interactions. This information will be needed for each member of your household ordering prescriptions through the Express Scripts Pharmacy.
8. Can I send in more than one prescription at a time?
Yes. Express Scripts will process all of the prescriptions you mail to their pharmacy according to your benefit.
9. How do I pay for my prescription?
Express Scripts encourages that all orders include payment to allow processing without delay. Orders may be paid for by:
• Flexible Spending Account (FSA) debit card
• VISA®, MasterCard®, American Express® or Discover®
• Personal check or money order • Bill Me Later® – offering payment flexibility with pay-now or pay-later options
10. How will I know if I have an outstanding balance?
You will receive an invoice with each order processed by Express Scripts. Additionally, monthly statements are sent to members with outstanding balances.11. How long will it take to process my order?
Once your order is received, please allow 10 to 14 days for your order to be delivered to your home. Express Scripts recommends first time users of the Express Scripts Pharmacy obtain at least a 30-day supply of medication prior to submitting your mail order request. If the prescription order has insufficient information, or if we need to contact you or your prescribing doctor, delivery could take longer. Express Scripts advises for first time users of the Express Scripts Pharmacy to ask your doctor for two signed prescriptions:
1 Bill Me Later is a third party credit account subject to credit approval. Creditworthiness is determined by CIT Bank. CIT Bank will review and consider a member’s credit report and other credit-related information prior to approval. Finance charges may apply if paid over time. S
• One for an initial supply to be filled at your local pharmacy.
• The second for up to a 3-month supply with refills to send to Express Scripts.
When Express Scripts contacts your doctor on your behalf to obtain a new prescription for Home Delivery, the process typically takes 2-3 weeks. If your doctor cannot be reached, you will be notified via phone, if a valid phone number is on file, or a letter will be mailed to you.
12. How will my order be mailed?
Orders are shipped in a non-descript, tamper-proof packaging by first class mail and are delivered by your normal carrier, unless the drug requires special handling such as refrigeration. There is no indication on the package that it is from a pharmacy. At your request, Express Scripts can mail your prescriptions to a secondary address.
13. My medication needs to be stored in the refrigerator. How will it be mailed?
The Express Scripts Pharmacy employs special processes for the handling and shipment of refrigerated prescription drugs. These processes are designed to maintain temperature within the range approved in the drug product's labeling. Whenever the Express Scripts Pharmacy ships refrigerated prescriptions, special packaging and coolant packs are used to ensure that your medications arrive in peak condition.
14. Can I have my prescription sent overnight?
Overnight shipping options may be available upon request and require additional shipping charges. For information on pricing and availability contact Express Scripts at 1-866-527-8878. Please note that overnight shipping refers to shipping only; normal processing time still applies.
15. How do I refill my prescriptions? Express Scripts now offers Auto Refills, a Home Delivery service enhancement designed to assist you in never running out of your medication. After enrolling your maintenance prescriptions in the program, Express Scripts will automatically calculate your prescription usage and day’s supply remaining. When it’s time to refill your prescription, Express Scripts will fill your maintenance prescriptions automatically for you and mail them to your home. Through your preferred method of communications, we will send you notification 7 days before we begin processing your next refill. You can change the next processing date or cancel the prescription from the automated refills service anytime before processing begins.
There are 3 convenient ways to enroll according to your preference:
1. , click on “Refill Prescriptions” and
select the prescriptions you would like to have automatically refilled.
2. At the time of refilling your prescription, we ask you if you want to enroll the
prescription in Auto Refills. If you answer yes, there is nothing more for you to do. We will begin automatically refilling your prescription on all future refills.
3. You can speak directly to an Express Scripts patient care advocate to enroll your
If you choose not to enroll in Auto Refills, you may order refills by the following methods: You may place orders for refills online by using the Express Scripts website. Mail: You may order a refill using the refill request form included in your initial prescription package. These should be mailed to the following address:
Express Scripts P.O. Box 66583 City, State 63166
Telephone: 1-866-527-8878 – You may order refills 24-hours a day by opting to: • Talk directly to a patient care advocate, or
• Use a touch-tone phone to input refill orders electronically by entering your member ID
16. How do I know Express Scripts will fill my order correctly?
Registered pharmacists inspect every prescription filled by the Express Scripts Pharmacy to make sure they are filled accurately and promptly.
17. Is Home Delivery as safe as using a retail pharmacy?
The Express Scripts Pharmacies have a higher accuracy rate than retail pharmacies.
Express Scripts Pharmacies achieve a higher accuracy rate through: • Automation
18. Will I get brand or generic medications?
This is a decision made by you and your physician. You may save money with FDA-approved generic equivalents. Where permitted by applicable law, generics may be dispensed when appropriate and permitted by your physician. If your doctor writes the
prescription for a brand medication and you would like the brand to be dispensed, please write “brand only” on a note included with the prescription. Our pharmacists will honor this request. Selecting brand medications over generic medications will increase your copayment.
19. What is the difference between a chemically equivalent generic medication and a therapeutically equivalent generic medication?
• Chemical equivalence occurs when a brand and generic drug comprise the same
molecule. Example: Brand Prilosec® and generic omeprazole are chemical equivalents; the active ingredient in both products is the molecule omeprazole.
• Therapeutic equivalence occurs when a brand and generic drug provide the same
health benefit. Example: Nexium® and the generic omeprazole are different molecules, but are essentially identical in terms of health benefit.
20. What happens if my medication is on manufacturer backorder?
Manufacturer backorders are not a common occurrence; however, if the manufacturer is experiencing difficulty supplying a medication and is unable to provide a date of availability, Express Scripts will notify you by phone. Typically, local pharmacies experience the same difficulties in supplying these medications and a new therapy may be needed. In these instances, you can receive up to two fills of the new medication at a local pharmacy. You then have the choice to continue filling at the local pharmacy and paying 100% of the cost of the medication, or to use Home Delivery with the Express Scripts Pharmacy.
21. Where do I call with additional questions or for help?
You can contact Express Scripts at 1-866-527-8878 and a patient care advocate will be able to help answer your questions. In addition, you can speak to a pharmacist 24-hours a day, every day. A patient care advocate can connect you at your request. Standard business hours for pharmacists are Monday through Friday, 7:00 am – 10:00 pm central standard time and Saturday, 7:00 am – 3:00 pm central standard time. If your request to speak to a pharmacist is outside of the pharmacists’ normal business hours, a pharmacist for additional information.
22. How will moving my prescriptions affect the local pharmacies?
Your maintenance medication program provides an affordable way of obtaining your maintenance medications. Under this program, you can receive up to two fills of certain maintenance medications at a local pharmacy. You then have the choice to continue filling at the local pharmacy and paying 100% of the cost of the medication or to use Home Delivery with the Express Scripts Pharmacy at your home delivery copayment. You will continue to use your local pharmacy for acute medications such as antibiotics and any over-the-counter needs. You can also use your local pharmacy for those maintenance medications that are not part of this program for your normal retail copayment. While using the Express Scripts Pharmacy, you will have the opportunity to speak with a pharmacist, if needed, by calling Express Scripts at 1-866-527-8878. A patient care advocate can connect you to a pharmacist upon request.
23. My written prescription was returned to me by Express Scripts. Why?
Express Scripts’ first priority is to get patients their prescriptions; however, Express Scripts must call physicians when they have a clinical or administrative concern about a prescription. Express Scripts makes up to two attempts to contact physicians within two business days. The order will be held until the end of the second day, if necessary, awaiting a response from the physician. If Express Scripts does not receive a response by the end of the second day, a letter is sent to you explaining the situation. Express Scripts pharmacists are in constant contact with physicians, calling on approximately 25% to 30% of all new prescriptions received. Express Scripts will also return the prescription to you if appropriate.
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Maintenance Medication Program