Prescription Benefit - Frequently Asked Questions
How can I get a Prescription Benefit ID Card?
You will receive the pharmacy identification card approximately 2 weeks after selecting your UK HealthCare benefit. The ID card will come directly from Express Scripts and will have only the cardholder’s name (the individual who is the primary subscriber) on it; however, this card may be used by any family member you have included in your HealthCare Benefit. You will also receive a copy of the UK Formulary (Drug List) and information about the mail service pharmacy in this ESI packet. NOTE: If you need prescriptions before you receive your ID card, UK Employee Benefits can issue a temporary ID card.
What pharmacies can I use?
The Express Scripts nationwide retail pharmacy network includes most large pharmacy chains and small independently owned pharmacies. Check the Express Scripts Web site at www.express-scripts.com, or call 1-877-242-1864 (option 4), to locate a pharmacy near you.
How can I get my 90-day prescriptions at home?
Your prescription benefit includes a home delivery program through Express Scripts Mail Pharmacy Service. Please see the UK Benefits website for detailed information and forms, check the Express Scripts website, or call 1-877-242-1864 (option 0 to speak with an Express Scripts Patient Care Advocate) to get started. Please allow 14 business days to receive your prescription.
Can I get my 90-day prescriptions at a local pharmacy?
No. There is one exception: The Kentucky Clinic Pharmacy can fill your 90-day prescriptions ONLY if you see a UK Healthcare physician.
How can I get reimbursed for prescriptions that I purchased without my prescription ID card?
Claims must be filed within twelve (12) months of receiving a prescription. Request a claim form from UK Employee Benefits Customer Service (1-800-999-2183 or 859-257-9555), and select “1” OR, download the form from the ESI website (www. ).
What medications are covered?
There is a 2006-07 University of Kentucky Formulary included in your Express Scripts ID packet, or you may also click here to view a printer-friendly version of the formulary online.
The formulary changes during the year when:
- a generic drug becomes available to replace the brand name drug (the brand name drug moves to non-preferred coinsurance rate)
- the drug becomes available over the counter (no longer covered under the pharmacy benefit)
- the drug is part of step therapy, prior authorization, quantity limit controls (could happen during the year)
- new drugs are approved
What is Step Therapy?
Step Therapy applies to new prescriptions in certain drug groups. If you have not had one of the medications in these drug groups filled within the previous 130-days, the prescription is not considered a current prescription and Step Therapy will be enforced. Within these special drug groups (see UK Benefits website for current list), your plan requires the use of less expensive first-line prescription drugs before the plan will pay for more expensive second-line drugs.
When the prescription is for a second-line drug is processed at your pharmacy, the on-line computer system will scan your recent prescription records, If the system finds a record for a first-line alternative filled within the previous 130 days or another second-line drug in the same drug group, Step Therapy will not interrupt the dispensing process. If the system does not find a record of a prescription fir a first-line alternative or the second-line medication in the same drug class, it will alert the pharmacist that your prescription is not a covered benefit.
In certain situations you may be granted a prior authorization for a second-line drug if specific medical criteria have been met without the trial of a first-line drug. Appropriate medical documentation must be communicated to ESI’s prior authorization department, or to the UK Prescription Benefit Pharmacist.
How can I get injections?
CuraScript is a pharmacy management program specializing in the provision of high-cost biotech and other specialty injectable drugs. Under this program, your retail pharmacy can dispense only the first injection prescription. Refills on specialty injectable medications are not available at retail pharmacies. After one fill, refills are covered only through CuraScript or the Kentucky Clinic Pharmacy. There are some medications that are ONLY available from CuraScript. Please check the UK Prescription Benefits page (www.express-scripts.com)
What will my prescription cost?
To see how much you’ll pay for a specific drug, use the “Price Check” feature on the ESI website. You can also contact your UK Prescription Benefit Pharmacist.
