Get the most from your prescription-drug benefit 2018
Welcome to Express Scripts At Express Scripts, the company chosen by Ohio State Highway Patrol Retirement System to manage your prescription-drug benefit, your health is important to us. We know there s a person behind every prescription we fill, and we re ready to serve you. What s Inside Your benefit at a glance...2 Your plan s preferred medications...2 Prior authorization...2 Step therapy...5 Filling your prescriptions...6 Using home delivery from the Express Scripts Pharmacy... 6-7 Using a participating retail pharmacy...8 Using an out-of-network pharmacy...8 Accredo the Express Scripts specialty pharmacy...10. Vaccinations...11
Your benefit at a glance You have choices when it comes to having your prescriptions filled. Express Scripts ensures that you have access to high-quality, cost-effective medications through a network of retail pharmacies and by offering convenient home delivery of your maintenance medications those medications you take on an ongoing basis from the Express Scripts Pharmacy SM. Your copayments are based on the type of prescription you have filled and where you have it filled: OHIO STATE HIGHWAY PATROL RETIREMENT SYSTEM PLAN Retail network pharmacy copayments (up to a 34-day supply) $15 for each generic drug $30 for each preferred brand-name drug *Member responsible for the full cost of nonpreferred brand-name drugs Home delivery from the Express Scripts Pharmacy SM copayments (up to a 90-day supply) $30 for each generic drug $60 for each preferred brand-name drug *Member responsible for the full cost of nonpreferred brand-name drugs Your preferred medications Ohio State Highway Patrol Retirement System (HPRS) and Express Scripts have worked together to develop a preferred drug list the medications covered under your plan. The preferred drug list offers a wide selection of generic and brand-name prescription drugs chosen to help keep prescription-drug costs down.. You can find HPRS s complete preferred drug list at Express-Scripts.com. Medications requiring prior authorization If you are currently taking a medication that is not on the preferred drug list, a prior authorization will be needed for approval. To get a prior authorization request started, have your healthcare professional contact your Express Scripts prior authorization specialist at 800.417.8164. Important facts about generic drugs Today, nearly 8 in 10 prescriptions filled in the U.S. are for generic drugs. All generic drugs are approved by the U. S. Food & Drug Administration (FDA) and must be equivalent to the brand-name drug 1. The FDA requires generic drugs to have the same active ingredient, strength, dosage form and route of administration as the brand-name drug. The generic manufacturer must prove its drug is the same (bioequivalent) as the brand-name drug. All manufacturing, packaging and testing sites must pass the same quality standards as those of brand-name drugs. Many generic drugs are made in the same manufacturing plants as the brand-name drugs. 1 Source: http://www.fda.gov/drugs/resourcesforyou 2 3
The benefit of step therapy Step therapy is all about health and value about getting the most effective medication for your health and money. That means using a tried-and-true medication that s proven safe and effective for your condition at the lowest possible cost to you and your plan sponsor. How does step therapy work? Step therapy is designed for people who regularly take prescription drugs to treat ongoing medical conditions such as arthritis, asthma or high blood pressure. Prescription medications are grouped into two categories: Step 1 medications are generic drugs that have been rigorously tested and approved by the FDA. Generics should be prescribed first because they can often provide the same health benefits as higher-cost medications. (See page 3 for more information.) For more information on step therapy in your benefit plan, visit Express-Scripts.com or call 866.472.6249. Step 2 medications are brand-name drugs such as those you see advertised on TV. They re recommended only if a Step 1 medication doesn t work for you. Step 2 medications almost always cost you and your plan sponsor more than Step 1 medications. What if my doctor prescribes a Step 2 medication? Ask if a generic (Step 1) medication may be right for you. Please share your formulary the list of prescription drugs covered by your plan with your doctor. The pharmacy will not automatically change your prescription; your doctor must write a new prescription for you to change from a Step 2 medication to a Step 1 medication. If a Step 1 medication is not a good choice for you, then your doctor can request prior authorization (described in more detail on page 2) to determine if a Step 2 medication will be covered by your plan. Who decides which prescription drugs are included in step therapy? A panel of independent licensed physicians, pharmacists and other medical experts work with Express Scripts to recommend medications for inclusion in the step therapy program. Together, they review the most current research on thousands of prescription drugs tested and approved by the FDA for safety and effectiveness, recommending appropriate prescription drugs for the program. HPRS then selects the medications that will be covered on your prescription-drug plan. For more information on step therapy in your benefit plan, visit Express-Scripts.com or call 866.472.6249. 4 5
When you use the Express Scripts Pharmacy, you can count on: A rating of 99.99% in accurately filling every prescription, compared to 98.30% at retail 2 A 90-day supply of your medications for less than you d pay at your retail pharmacy Free standard shipping in a plain weather-resistant pouch Flexible payment options and auto refills A registered pharmacist available at any time, day or night, year round Refill orders placed at your convenience, by telephone or online 2 Source: Center For Pharmacy Operations and Design, Harrison School of Pharmacy, Auburn University Filling your prescriptions You have two ways to fill your prescriptions, depending on your medication needs. For long-term medication needs for example, drugs used to treat high-blood pressure or diabetes home delivery from the Express Scripts Pharmacy is the convenient, safe way to get your prescription. For short-term medication needs, such as antibiotics for strep throat or pain relievers for an injury, filling at a participating retail pharmacy is optimal. Both options are detailed below. Using home delivery from the Express Scripts Pharmacy For long-term medication needs, the Express Scripts mail order Pharmacy is required for the prescription drugs you take regularly to treat ongoing conditions. Your medications are delivered safely and conveniently to your home simply the best place to be. An Express Scripts Pharmacy order form was included in your Welcome Kit with your member ID card as well as with this HPRS handbook. You can print additional forms if needed or start home delivery by visiting StartHomeDelivery.com or by calling 866.472.6249. Three ways to get started with home delivery Online 1. Ask your doctor to write a prescription for up to a 34-day supply and fill it immediately at your local pharmacy. 2. After you ve filled your 34-day prescription, go to StartHomeDelivery.com, click Register Now and follow the prompts to set up your account. 3. When your registration is complete, you will be notified of an opportunity to save on your new prescription and any other savings opportunities you may have. Follow the prompts and Express Scripts will contact your doctor to obtain a prescription for up to a 90-day supply of your medication. By mail 1. Ask your doctor to write two prescriptions: one for up to a 34-day supply that you can fill immediately at your local pharmacy; one for up to a 90-day supply of your medication, plus refills for up to one year. 2. Complete an order form for home delivery from the Express Scripts Pharmacy. You can print a form from StartHomeDelivery.com. 3. Return the completed order form, your written prescription for your 90-day supply and payment 3 to: Express Scripts P.O. Box 66567 St. Louis, MO 63166-6567 3 To help avoid delays in filling your prescription, be sure to include payment with your order. By fax from your doctor 1. Ask your doctor to write two prescriptions: one for up to a 34-day supply that you can fill immediately at your local pharmacy; one for up to a 90-day supply of your medication, plus refills for up to one year. 2. Complete an order form for home delivery from the Express Scripts Pharmacy. You can print a form from StartHomeDelivery.com. 3. Have your doctor or a member of your doctor s staff fax your completed order form to Express Scripts at 800.636.9494. Faxes must be sent from your doctor s office. Faxes from other locations, such as your home or workplace, cannot be accepted. Free standard delivery from the Express Scripts Pharmacy Your medication will be mailed to your home via standard U.S. Postal Service delivery at no charge,* within five business days from the day we receive the prescription. Your medication will arrive in a plain, weather and tamper-proof pouch, with packaging accommodations made for temperature control if needed. * Overnight delivery is available, at an additional cost. The cost varies depending on the destination city and state. 6 7
Fewer Refills Saves You Money If your doctor writes a prescription for a 34-day supply of medication with 11 refills (for a total of 12 fills ), Express Scripts will fill your prescription for a 90-day supply of medication in a single fill. You ll then have three additional 90-day refills remaining. 4 We refer to this as consolidation of refills. What s important for you to know is this consolidation saves you money by requiring fewer copayments. We prefer that your doctor write a prescription for a 90-day supply with three refills. Express Scripts will, if possible, consolidate your refills to save you money. Refills for some medications such as controlled substances, sleeping medications, inhalers and certain other drugs can t be consolidated. What does this mean for you? Consolidating your prescription will enable you to receive a 90-day supply for a single homedelivery copayment rather than pay three separate 34-day copayments. And, you won t need to refill as often with a 90-day supply. Remember, it s best if you let your doctor know in advance that your prescription for home delivery from the Express Scripts Pharmacy should be written for a 90-day supply, with three refills. 4 If you live in the states of Oklahoma or Texas, Express Scripts is prohibited by state law from automatically consolidating your prescription. To save yourself some money, have your doctor write your prescription for a 90-day supply with three refills. Using a participating retail pharmacy For short-term medication needs, a retail pharmacy is your most convenient option. When filling prescriptions that you need immediately, simply present your Express Scripts member ID card and written prescription to your pharmacist and pay your copayment as shown on page 3. You can locate your nearest participating retail pharmacy at any time at Express-Scripts.com or by calling 866.472.6249. Using an out-of-network pharmacy If you use a pharmacy that s not covered in your network, you must pay the entire cost of the prescription and then submit a claim for reimbursement. Claim forms are located online at Express-Scripts.com and can be requested by calling HPRS Member Services at 866.472.6249. Claims must be submitted within 365 days of the prescription purchase date. Continuing to fill at retail After having the same prescription filled twice at a retail pharmacy, you are required to refill that prescription through home delivery from the Express Scripts Pharmacy (details on page 6). However, if you continue to refill that prescription at your retail pharmacy, you ll pay 100% of the cost. 8 9
Accredo, your specialty pharmacy Accredo, the full-service Express Scripts specialty pharmacy, provides personalized care to patients with chronic, complex health conditions. Accredo offers several comprehensive diseasespecific patient-care management programs: 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 clinicians and disease-specific educational materials available 24/7 Convenient medication delivery coordinated delivery to your home, doctor s office or any other approved location Refill reminders ongoing refill reminders from a patient care coordinator Language assistance translation services are available for non-english speaking patients For additional information about the services available to you through Accredo, please call 866.848.9870. Vaccinations The HPRS health plan provides two convenient ways for you to receive vaccinations. 1) Visit your local pharmacy. The Express Scripts Vaccination Network has thousands of participating pharmacies, including Kroger and CVS. Please call your pharmacy to confirm a good time to receive a vaccination. If your vaccination requires a prescription, your pharmacy can arrange to get this directly from your doctor. When you go to get your vaccination, present both your Express Scripts and your medical card (Aetna or Medical Mutual). Most pharmacies will submit the insurance claim for you. In some cases, you may be asked to pay the pharmacy directly. If so, you may be eligible to be reimbursed by submitting an itemized receipt and a claim form to Express Scripts. 2) Contact your doctor to set up an appointment. When you go to get your vaccination, present both your Express Scripts and your medical card (Aetna or Medical Mutual). If the vaccination is the only reason you are seeing your doctor, you should not be asked to pay a copayment. Most doctors will submit the insurance claim for you. In some cases, you may be asked to pay the doctor directly. If so, you may be eligible to be reimbursed by submitting an itemized receipt and a claim form to Express Scripts. We re here to help Through programs specific to your condition, you can receive a complete range of services and specialty medications many of which can be very costly and are often unavailable through retail pharmacies. The conditions include but are not limited to: Cancer Hemophilia Hepatitis Multiple sclerosis Psoriasis Pulmonary arterial hypertension Respiratory syncytial virus Rheumatoid arthritis 10 11
At-a-glance guide Notes Online If you have internet access, you can use the Express Scripts website for quick access to information. Register today at Express-Scripts.com to: Order refills of your prescriptions from the Express Scripts Pharmacy Track the status of your prescriptions from the Express Scripts Pharmacy Check prescription pricing and coverage Request Express Scripts Pharmacy home delivery order forms and envelopes Locate a participating retail pharmacy and download claim forms Obtain health information and much more By phone Call 866.472.6249 speak with a Member Services representative and: Ask questions about your prescription-drug benefit Request Express Scripts Pharmacy home delivery order forms or envelopes Find the nearest participating retail pharmacy Request claim forms for prescriptions filled at out-of-network pharmacies Speak with a registered pharmacist Order refills All services listed are available 24 hours a day, 7 days a week. To access TTY service for hearing-impaired members, call 800.899.2114. By fax from your doctor Your doctor may fax your prescriptions to the Express Scripts Pharmacy at 800.636.9494.
. Helpful numbers you may need Member Services...866.472.6249 Refill Prescriptions...866.472.6249 Fax Prescriptions...800.636.9494 TTY...800.899.2114 Prior Authorization...866.472.6249 Accredo Specialty Pharmacy...866.824.5662. Your privacy is important Express Scripts is committed to meeting HPRS guidelines related to protecting your privacy as well as those of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA includes provisions to ensure privacy of your personal health information. In order to provide you with pharmacy services and to administer your prescription-drug benefit, we may require personal health and prescription-drug information from you, your doctor or your retail pharmacy. We use this information only to verify your identity and pricing under program; to check for adverse drug interactions; to accurately 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 HPRS, Express Scripts is required to provide individual pharmacy claims data for payment processing and record keeping without identifying individual members. As part of the contract, we are also obligated to report any unusual activity that may constitute fraud or abuse of benefits. HPRS and Express Scripts may also use information and prescription data gathered from claims submitted for reporting and analysis purposes without identifying individual members. 2012 Express Scripts Holding Company. All Rights Reserved. 12-1335