CBP City of New York Employee and Retirees

Getting More Information
Express Scripts
Within the U.S.
877.534.3682 (toll free)
Every day, 24 hours a day
Outside the U.S.
877.534.3682 (ext. 37-8710)
Every day, 24 hours a day
Express-Scripts.com
CuraScript
(Express Scripts Specialty Pharmacy)
866.848.9807 (toll free)
Weekdays, 8 a.m. to 9 p.m.
Saturday, 9 a.m. to 1 p.m.
CuraScript.com
Welcome to Express Scripts
HOW TO GET THE MOST FROM YOUR PRESCRIPTION-DRUG Benefit
Your New Prescription-Drug Benefit
© 2010 Express Scripts, Inc. All Rights Reserved 10-2199
welcome
What’s Inside
Welcome to Express Scripts, the company chosen by Group Health, Inc. to manage
your prescription drug benefit.
•What’s inside
•Your plan’s preferred medications............................................................ 3
•Two ways to fill your prescriptions............................................................ 3
•CuraScript®............................................................................................. 7
•Your personal health and prescription information....................................8
•Quick reference.......................................................................................9
Quick reference
Online services
If you have Internet access, you can take advantage of Express Scripts’ website. Register
today at www.express-scripts.com to:
• Check your combined medical and prescription deductible and out-of-pocket maximums.
Order refills of your Home Delivery prescriptions.
• Track the status of your Home Delivery prescriptions.
• Check prescription pricing and coverage.
• Locate a participating retail pharmacy and print claim forms.
• Request Home Delivery order forms and envelopes.
• Obtain health information and much more.
Important telephone numbers
You can reach Express Scripts at the numbers below. All services listed are available at any
time, day or night, 365 days a year.
Member Services 877.534.3682.
Call Express Scripts to:
• Ask questions about your prescription drug benefit.
• Request Home Delivery order forms or envelopes.
• Find the nearest participating retail pharmacy.
• Request claim forms for prescriptions filled at non-participating pharmacies.
• Speak with a Member Services representative.
• Speak with a registered pharmacist.
To refill prescriptions, call 800.227.8338.
Your doctor may fax your prescriptions to the Group Health Express Scripts Pharmacy fax line
at 800.213.3032. To access TTY service for hearing-impaired members, call 800.899.2114.
Getting Started with Express Scripts
At Express Scripts, the company chosen by Group Health to manage your
prescription-drug benefit, we’re ready to serve you.
You should have already received your member ID card. You’ll need your card
when you have a prescription filled at a participating pharmacy or order your
prescriptions online.
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Your plan’s preferred medications
Your plan includes a list of prescription drugs that are “preferred” because they help to
keep prescription drug costs down. This Preferred Drug List, drugs covered under your plan,
contains a wide selection of generic and brand medications. You can access the Preferred
Drug List at www.express-scripts.com, or by calling Express Scripts at 877.534.3682.
Coverage for Over-the-Counter (OTC) medications
• A list of the most commonly prescribed prescription products with over-the-counter
equivalents can be found at www.express-scripts.com or call Express Scripts at
877.534.3682.
Step Therapy
Brand-name medications for certain disease states will require Step Therapy. Examples
of a few of these disease states are asthma/ allergies, depression and high cholesterol.
Medications for disease states such as these will only be covered in situations where a
lower-cost alternative medication has not been effective. To determine if your medication
requires Step Therapy, or is subject to limitations, please call Express Scripts at
877.534.3682. Before the Plan will pay for the medication, it requires you to try an equally
effective but lower-cost generic prior to filling the brand-name medication.
Your personal health and prescription
information
To provide you with pharmacy services and administer your prescription benefits,
Express Scripts may require personal health and prescription drug information from
you, your doctor or your retail pharmacy. We use this information to verify your identity
and pricing under the program, to check for adverse drug interactions, to process your
prescription order, and to keep you informed about the proper use of your medications,
available treatment and benefit options.
Under the terms of our contract with GHI, Express Scripts is required to provide to GHI
individual pharmacy claims data for payment processing and record-keeping without
identifying individual members. As part of the contract, Express Scripts is obligated to
report any unusual activity that may constitute fraud or abuse of benefits.
GHI and Express Scripts also may use information and prescription data gathered
from claims submitted for reporting and analysis purposes without identifying
individual members.
If you have a discontinuance or lapse in therapy greater than 130 days while using the
brand-name medication and need to restart therapy, you will be subject to another review
under the Step Therapy program to determine if the cost of the brand-name medication will
be covered under the Plan.
Two ways to fill your prescriptions
You have two ways to fill your prescriptions: either at a participating retail pharmacy or
through Home Delivery from the Express Scripts Pharmacy.
Note regarding controlled substances: Kentucky and Hawaii state laws require you to provide
your Social Security number to the pharmacy before it can dispense your medications. This
applies to prescriptions filled at retail and through Home Delivery .
1. Short-term medication needs
Filling your prescriptions at a participating retail pharmacy
The retail pharmacy is your most convenient option when filling a prescription that you need
immediately (example: antibiotics for strep throat or pain relievers for an injury). Simply
present your Express Scripts member ID card and written prescription to your pharmacist
and pay the required amount as shown on page 3.
You can locate the nearest participating retail pharmacy at any time online at
www.express-scripts.com or by calling Express Scripts at 877.534.3682.
page 3
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Submitting a prescription by fax
1. Ask your doctor to write a prescription for up to a 60-day supply of your medication,
plus refills for up to one year, if appropriate.
2. Complete a Home Delivery order form. You can print an order form from the
Express Scripts website at www.express-scripts.com.
3. Have your doctor or a member of your doctor’s staff fax your order form to
Express Scripts at 1.800.636.9494. Faxes must be sent from your doctor’s office.
Faxes from other locations, such as your home or workplace, won’t be accepted.
Your prescription drug will be mailed to your home via standard U.S. Postal Service delivery
within ten to fifteen business days from the day we receive the prescription. If you request
overnight delivery, you’ll be responsible for the cost. Availability of and cost for overnight
delivery vary based on location.
CuraScript®,the Express Scripts Specialty
Pharmacy
CuraScript, the Express Scripts Specialty Pharmacy, is a full service specialty pharmacy
that provides personalized care to individuals with chronic, complex health conditions.
CuraScript offers several comprehensive patient care management programs specific
to major medical conditions such as cancer, hemophilia, hepatitis, multiple sclerosis,
psoriasis, pulmonary arterial hypertension, respiratory syncytial virus, rheumatoid arthritis,
and more. Through the patient care management programs you can receive a complete
range of services and specialty medications — many of which are costly and often
unavailable at retail pharmacies.
CuraScript provides:
2. Long-term medication needs
• Patient Counseling — Convenient access to highly trained specialty experts, including
pharmacists, nurses and patient care coordinators who provide the support you need to
manage your condition
• Patient Education — Disease specific educational materials and clinicians available
24/7
• Convenient Delivery — Coordinated delivery to your home, your doctor’s office or any
other approved location
• Refill Reminders — Ongoing refill reminders from a patient care coordinator
• Language Assistance — Language translation services are provided for non-English
speaking patients
To learn more, please call 866.848.9870.
Filling your prescriptions through Home Delivery from the Express Scripts Pharmacy Home
Delivery is your best option for buying the prescription drugs you take on a regular basis.
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NOTE: CuraScript®, the Express Scripts Specialty Pharmacy, dispenses specialty medications
through the mail. Medications obtained through CuraScript are limited to a 30-day supply.
For more information, please refer to page 10 in this handbook.
Using an out-of-network pharmacy
If you use a non-participating pharmacy, you must pay the full cost of your prescription at
the point of sale and then file a claim form with GHI to request benefits. After you meet the
deductible(s), GHI will reimburse you for covered prescriptions at the amount that GHI would
have paid to a GHI participating pharmacy for the prescription, less the applicable copay or
coinsurance. You are responsible to pay any difference between GHI’s payment and the cost
of your prescription. You may contact Express Scripts Member Services at 1.877.534.3682, to
obtain info on where to submit claims and to obtain a claim form.
page 4
Filing a claim
Claims must be submitted within 365 days of the date the prescription was filled. Claim
forms are located online at www.express-scripts.com and can be requested by calling your
Group Health Member Services team at 877.534.3682.
Home Delivery from the Express Scripts
Pharmacy
After getting the same prescription filled two times at a retail pharmacy, it’ll be more cost
effective for you to refill that prescription through Home Delivery. However, if you continue to
refill that prescription at your retail pharmacy, you’ll pay 100% of the cost.
Getting started with Home Delivery from the
Express Scripts Pharmacy
If you’re planning to use Home Delivery, ask your doctor for two prescriptions: one for up to a
30-day supply that you can fill immediately at your local pharmacy and another for a 60-day
supply, plus refills for up to one year, if appropriate. A Home Delivery order form is included
in your member ID card packet.
You also can get a Home Delivery order form at any time online at www.express-scripts.com
or by calling Express Scripts at 877.534.3682.
Submitting a prescription by mail
1. If appropriate, ask your doctor to write a prescription for up to a 60-day supply of your
medication, plus refills for up to one year.
Benefits of Home Delivery
• Buy up to a 60-day supply of your medications for less than you’d pay at your
local pharmacy.
• Prescriptions are delivered directly to your home in a plain, weather-resistant pouch
for privacy and protection; standard shipping is free. You can request to have your
prescriptions sent by overnight delivery. You’ll be responsible for the cost. Availability of
and cost for overnight delivery vary based on location.
NOTE: If overnight delivery is requested, prescriptions are not filled and sent the same day
as received. Please allow 3-5 business days for processing.
• Speak with a pharmacist Monday through Friday between 8 a.m. and 11 p.m. Eastern
time. After hours and on weekends, a pharmacist will be paged and your call will be
returned within one hour.
• Once you begin using Home Delivery, you can order refills by telephone or online at
your convenience.
page 5
2. Complete a Home Delivery order form. You can print an order form from the Express
Scripts website at www.express-scripts.com.
3. Insert your completed order form, your written prescription, and payment into an
envelope and mail it to Express Scripts:
Express Scripts
Home Delivery Program
P.O. Box 510
Bensalem, PA 19020-0510
Note: To help avoid delays, be sure to include payment with your order.
You can find out the price of the prescriptions by visiting the Express Scripts website at
www.express-scripts.com or by calling Express Scripts at 877.534.3682.
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