LOCAL 1014 PRESCRIPTION DRUG BENEFIT 

PRESCRIPTION DRUG BENEFIT

EXPRESS SCRIPTS

A Message from Expess Scripts:

Express Scripts

Express Scripts is committed to helping millions of Americans like you have access to affordable medications and the services you need to stay healthy.

MAIL ORDER PHARMACY SERVICE

If you need medication on an ongoing basis, see the Local 1014 Health and Welfare Plan Maintenance Drug List, you can ask your doctor to prescribe up to a 90-day supply of maintenance medication for home delivery or at your retail network pharmacy, plus refills for up to 1 year.  You pay one co-payment for each prescription or refill.  The Express Scripts Home Delivery Pharmacy Service fills mail order prescriptions only for drugs covered on the Local 1014 Health and Welfare Plan Maintenance Drug List.  Your medications will be delivered to you within 7 to 11 days after you mail your order. 

Learn about Express Scripts Home Delivery Service with no shipping cost: Click here 

First Time Users -- Ask your doctor to write a new prescription for up to a 90-day supply plus refills (if appropriate) for up to 1 year.  Prescriptions may be submitted:

o       Online – Visit www.express-scripts.com.  Once you are registered and logged in, scroll to the bottom of the “order center”, click on the “request a new prescription from your doctor” link, and follow the on-screen instructions.

o     By mail – Send the new prescription(s), along with the “Express Scripts Home Delivery Pharmacy Service Order Form” and the appropriate co-payment, to Express Scripts. The Pharmacy Service Order Form is available on the web at www.express-scripts.com or by calling 1-800-711-0917.

o     By fax – Ask your doctor to call the Express Scripts fax information line at 1-888-EASYRX1 (1-888-327-9791) for faxing instructions.  Only your doctor may fax a prescription.  Please be sure to give your doctor your member ID number.  You will be billed later.

Refilling Prescriptions – You can refill your home delivery prescriptions online, by telephone, or by mail.  Have your member ID number, your prescription number, and your credit card number (including expiration date) available.

o      Online – Each time registered users log in to  www.express-scripts.com, available prescription refills will be displayed in the personalized “order center”, as well as within your prescription history.  From the order center, check the box next to the items you want to order and follow the on-screen instructions to check out.

o       By telephone – Call 1-800-4REFILL (1-800-473-3455) to use the automated refill system.  For hearing-impaired members call 1-800-759-1089.  To request Braille labels for Home Delivery Pharmacy Service prescriptions, call 1-800-711-0917.

o      By mail – Use the refill order form that will accompany your prescription.  Mail them with your co-payment to Medco Health in the return envelope. 

Paying for your Medication

You may pay by Credit Card (including Visa, MasterCard, Discover/NOVUS, American Express, or Diners Club), Check or Money Order.  For orders by credit card, there is also an automatic payment program that you can join by calling 1-800-948-8779 or by enrolling online at www.express-scripts.com. 

Express Scripts Website

If you have Internet access, you can visit  www.express-scripts.com.  To get the most from the website, click on the “register now” link and have your member ID number available.  Follow the instructions to complete the one-time registration.  The next time you visit, you will only need to enter your email address and password to log in. 

On the website you can:

o       Order and track the status of your home delivery prescriptions.

o       Compare pricing for brand name and generic drugs.  However, refer to the Local 1014 Health and Welfare Plan Maintenance Drug List for the drugs covered on the 90-dayRetail and 90-day Mail Order options.

o       Review your prescription history and expenses, as well as check and pay balances.

o       Print Home Delivery Pharmacy Service order forms or request they be mailed to you.

o       Request claim forms for prescriptions filled at non-participating pharmacies.

o       Locate and get directions to a participating retail network pharmacy.

o       Receive health and wellness information, tools, and resources.
 

RETAIL NETWORK PHARMACY SERVICE

The retail network pharmacy service can fill prescriptions for up to a 30-day supply of medications or up to a 90-day supply of maintenance medications.  To find out whether a pharmacy participates in the retail network:

• Ask your pharmacist.
• Visit the Express Scripts website at  www.express-scripts.com and use the online pharmacy locator.
• Call 1-800-711-0917 and use the interactive pharmacy locator.

Ordering new prescriptions or refills at a participating retail pharmacy:

• Step 1: Show your ID card at the pharmacy.
• Step 2: Pay your co-payment (the pharmacist will tell you the amount.)

At non-participating pharmacies:

If you go to a retail pharmacy that is not part of the Express Scripts network, you must:

q       Step 1: Pay the full cost of the prescription.  Please be aware that although you can fill prescriptions at any pharmacy, you may incur additional charges at a non-participating pharmacy.

q       Step 2: Complete a direct reimbursement claim form and submit it to Express Scripts.  You will be reimbursed for the amount the medication would have cost at a participating pharmacy minus the co-payment. You can order claim forms online at www.express-scripts.com or by calling 1-800-711-0917 and using the interactive telephone system. 

Medications Requiring Prior Authorizations

Some medications are covered only for certain uses or in certain quantities.  The Local 1014 Health and Welfare Plan sets all coverage parameters.  For example, a drug may not be covered when it is used for cosmetic purposes.  Also, the quantity covered may be limited to certain amounts over certain time periods.  In these cases, your doctor may need to provide more information. 

The pharmacy will let you know if additional information is required by your plan.  You or the pharmacy can then ask your doctor to call a special toll-free number.  This call will initiate a review. Once the review is complete, the Local 1014 Health and Welfare Plan will notify you and your doctor of the decision.  If the review is approved, the letter will tell you the length of your coverage approval.  If the review is denied, the letter will include the reason for coverage denial and instructions on how to submit an appeal.