Prescription Benefit - Filling Prescriptions
At your local participating pharmacy:
Present your Express Scripts ID card to the pharmacist to get your immediate need (30-day supply) prescriptions filled at any one of over 40,000 chain and independent retail pharmacies participating in the Express Scripts national network.
Through Express Scripts Mail Service Pharmacy:
You are able
to receive by mail up to a 90-day supply of your medications.
Your medications will be delivered free of shipping costs within two
weeks (extra charge for faster shipping). You will be able to track
these prescriptions on the Express Scripts Web site, and reorder by
phone, mail or online (www.express-scripts.com). Order forms for
the mail service prescription drug program are available from Express
Scripts or the University of Kentucky Employee Benefits Office
(112 Scovell Hall or 321 Wethington Building).
Through Kentucky Clinic Pharmacy:
If you are under the care of a UK provider, you will be able to obtain both your immediate need (30-day supply) prescriptions AND your chronic need (up to 90-day supply) prescriptions at the Kentucky Clinic Pharmacy, on a walk-up (in person) basis.
Express Scripts Home Delivery FAQs:
1. Why did I get this letter about Express Scripts Home Delivery?
UK was presented with an opportunity to offer both members and the plan significant savings and access to some member programs offered through Express Scripts, by implementing this program. This is not a mandatory mail order program, just a program that requires members to communicate a choice. You still have full choice and flexibility about what pharmacy you use. You received this letter since you are currently taking a maintenance medication (a medication you take on an ongoing basis) for a chronic condition (high blood pressure, high cholesterol, diabetes, etc.).
2. My spouse received the letter about Express Scripts Home Delivery but I didn’t. Why didn’t I get a letter?
UK HR sent one letter per household to eligible members (those with a history of a maintenance prescription filled at a retail pharmacy). Express Scripts will follow up with a letter specific to each eligible member. If you each have qualifying maintenance Rxs you will each get a letter from Express Scripts.
3. How do I find out what my savings are?
When you get your letter from Express Scripts about Express Scripts Home Delivery it will state your specific savings opportunities based on the medications you have been getting filled. There are two versions of the Express Script letter. If your savings are greater than $20 then the letter will have a statement similar to “YOU HAVE A POTENTIAL SAVINGS OF <$125.00 (or whatever YOUR actual savings is calculated to be)>* PER YEAR”. If your savings are calculated to be less than $20 per year then your letter will not state a specific dollar amount in potential savings.
4. I am using one of the discount generic programs ($4 generics) that are available at Kroger’s and Wal-Mart. Do I need to switch to the Express Scripts Home Delivery Program?
The $4 and $10 generic programs that are available at major retailers are a great value to both the member and the plan. We strongly encourage you to continue to use these programs for any generic medications that are available through these programs. Your opportunities for savings will lie primarily with Brand Name medications and for generic drugs not included in these discount programs.
5. What do I do if I need to get an antibiotic or a prescription that I need right now?
The Home Delivery option is only for maintenance medications, those that you take every day for treatment of chronic conditions such as high blood pressure and diabetes that you would want to fill in 90-day supplies. For medications to treat an acute condition such as an infection or an allergic reaction you will still fill at the local pharmacy of your choice so that you can receive immediate treatment.
6. Can I get some of my prescriptions at Express Scripts Home Delivery and still get some at my local pharmacy?
Certainly! This is not an all or nothing program. You can pick and choose which, if any, medications you want to obtain from Express Scripts Home Delivery and which you want to get filled at your local pharmacy. Once you have your specific letter from Express Scripts you will have the list of your medications eligible for this program and you can inquire about individual savings on each of these medications before you decide. There may be factors other than cost that may guide your decision. If you are concerned about ready access to a medication and just aren’t comfortable with getting that particular medication through Home Delivery you can still pick and choose on any basis. Again, you have full choice, in how you use or not use this program.
7. I use Kentucky Clinic Pharmacy and get 90-day supplies on my maintenance medications. Can I still use Kentucky Clinic Pharmacy for 90-day supplies?
Kentucky Clinic Pharmacy remains the only retail pharmacy in which members can get a 90-day supply. That benefit is still available for members who qualify to use the Kentucky Clinic Pharmacy. Members must have a UK prescriber to utilize the Kentucky Clinic Pharmacy. There are, however, some members who are unable to use Kentucky Clinic Pharmacy as they don’t meet the requirement of using UK physicians. The Express Scripts Home Delivery Program allows these members to take advantage of the lower coinsurance percentages that are available for members getting 90-day fills.
8. I use Kentucky Clinic Pharmacy and get 90-day supplies on my maintenance medications and already get the discounts available for getting 90-days. Will my copays at Express Scripts Home Delivery for 90-day supplies be different than my copay for 90-day supplies at Kentucky Clinic Pharmacy?
Members using Kentucky Clinic Pharmacy and getting 90-day maintenance medications filled at that location are likely to have little opportunity for savings from this program. Kentucky Clinic Pharmacy remains as the only 90-day retail opportunity for members and the copay structure for 90-days from Kentucky Clinic Pharmacy is the same as that for Express Scripts Home Delivery. There are, however, some members who are unable to use Kentucky Clinic Pharmacy as they don’t meet the requirement of using UK physicians.
9. The letter says after my 3rd fill, I will have to pay the full cost of my prescription. Do my benefits end after 3 refills if I don’t want to use Express Scripts Home Delivery?
Nothing has changed in terms of your Prescription Benefits and the copay structure. The “full cost of your prescription” only comes into play if someone doesn’t call Express Scripts and indicate that he/she wants to keep their Rxs at their retail pharmacy. After the 3rd fill at a retail pharmacy the member would be responsible for the full cost ONLY until they call Express Scripts and tells them they want to keep using a retail pharmacy or start using the Home Delivery Service at the next fill. Once that is done, the pharmacy can reprocess the prescription and the member only pays the copay. It is fully reversible and is in place just to ensure that the member makes the choice.
10. The letter says after my 3rd fill, I will have to pay the full cost of my prescription. What if I am at a pharmacy on the weekend when the 888.772.5188 phone number isn’t being answered? Will I have to pay the full cost?
In this situation you will be able to call the number on the back of your Express Scripts ID card (1-877-242-1864) and request a “courtesy override” to allow you to get your medication at that time for the usual copay. The Home Delivery program will then follow up with you during their regular operating hours to obtain your decision to transfer your prescription to Express Scripts Home Delivery or to keep it at your retail pharmacy.
11. What if I don’t want to do this at all? Can I just tell them I don’t want any of my prescriptions through Express Scripts Home Delivery?
You have full choice in how to use or not use this program. If you don’t want to get any of your prescriptions through Express Scripts Home Delivery you can call and just tell them that. You will not have to go through each medication and opt out but just issue a blanket statement that you don’t want to participate at all.
To Opt Out Call: 888.772.5188 Monday through Friday, 7:30 am to 5:30 pm Central Time
12. If I want to participate, how do I sign up?
If you want to enroll you can call the number on your letter or enroll online. The Express Scripts Home Delivery program will contact your physician to get 90-day prescription orders on your behalf or you can mail in Rxs to Express Scripts. The pharmacists in the HR Benefits office can assist you in this process if you so desire.
EITHER:
Enroll online 24 hours per day, 7 days per week at www.StartHomeDelivery.com
OR
Call Express Scripts at 888.772.5188 Monday through Friday, 7:30 am to 5:30 pm Central Time. UK Pharmacist can be reached at (859) 323-1493.
13. What happens if I get started on a new maintenance medication after the start of this program on October 15th?
Unless you have opted out in total, you will be contacted by Express Scripts by mail and telephone, following your first fill at a retail pharmacy, about getting this new Rx through Express Scripts Home Delivery or keeping it at your local pharmacy. You will be contacted by Express Scripts again after your second fill if you have not notified them by this time. Once you have made your choice to opt out permanently, you will not need to opt out on a recurring basis for a given prescription. If you, as a member, have completely opted out for all medications you should not have to do so on future new maintenance prescriptions.
14. What if I change my mind later and want to change my decision?
You may enroll for Express Scripts Home Delivery at any future time you choose to do so. Your decision now to not participate has no bearing on your future ability to take advantage of any savings, convenience, or special program access this may afford you.
15. The letter states I may pay a higher price if I opt out of the Express Scripts Home Delivery. Are my prescription benefits changing?
Your copays will continue just as they have been all along.This program does not require you to use Express Scripts Home Delivery and does not change your prescription benefit in anyway. It just requires you to make a CHOICE and to communicate that choice about which medications you want to keep at your local pharmacy and which, if any, you want to move to Express Scripts Home Delivery.
