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    Pharmacy Benefit Manager – Express Scripts

    • Express Scripts will be the Pharmacy Benefit Manager under the Schools Health Insurance Fund. 
    • Member Services - Members can call Express Scripts Member Services at (800) 467-2006 or visit the website at – express-scripts.com
    • Register Your Account – Get the most out of your prescription benefits and set up your account at express-scripts.com.  (Access ID cards, refill medications, see which medications are covered, etc.)

     

    Copays 

    • Retail Copays - $8 Generic/$18 Brand
    • Mail Order Copays -  $8 Generic/$8 Brand
    • Retail and Mail Order Dispensing Limitation - Up to 90 day supply

     

    Network Considerations

    • Walgreen’s is not a participating provider.
    • Some Rite Aid’s are excluded as well as a few “mom and pop” shops.
    • CVS, Shop-Rite, Target, Walmart, Acme, and other large box chain pharmacies are in-network. 

     

    Mail Order

    • For maintenance medications, members should utilize the Express Scripts mail order program.  A 90 day supply of your medication will be conveniently delivered to your home.  See the attached flyer for options on how to set up your mail order delivery or contact Express Scripts at 603.1032 to get started.

     

    Specialty Medications

    • Specialty Medications require special handling, careful administration, and ongoing patient care management.  Specialty Medication’s must be ordered through the Express Scripts specialty pharmacy provider, Accredo. 
    • To get started, visit the Accredo website at accredo.com or contact them at 1-877-ACCREDO (222-7336). Please see the attached flyer for additional details about Accredo. 

     

    Formulary Considerations 

    • Formularies vary from one pharmacy benefit manager to another.  Under Express Scripts, some drugs are excluded, but there are FDA approved alternatives for all excluded drugs. 
    • If members have already tried the approved alternative and had an adverse reaction, they can have their provider file an appeal to prove medical necessity to remain on their existing drug. 
    • Members who have a drug denied due to a formulary restriction can contact the Beneservice team for assistance at 800-563-9929.  Beneservice can assist the member in working with the SHIF to get approval for a one-time 30 day courtesy fill if needed.