FAQ'S

General

Q: What is Express Scripts Pharmacy home delivery service?
A: The Express Scripts Pharmacy home delivery is a home delivery service available as part of your LEHB prescription drug plan. With Express Scripts home delivery, you will save when you fill your long-term prescriptions for up to a 90 day supply compared to a participating retail pharmacy (only 2 co-pays instead of 3). NOTE: You are required to use home delivery after 4 fills at the retail pharmacy for maintenance medications.

Q: Will my prescription drug copayments be changing?
A: Only if a change is mandated in an Act 111 Award.

Q: Will there be changed to my plan's list of preferred drugs?
A: Yes. Effective January 1st annually, your plan's formulary (a list of preferred medications) will change. As a result, some preferred medications will become non-preferred, and vice versa. You can log on to Express Scripts to view your formulary and find out which medications are preferred. If you are taking a brand-name drug that is about to become nonpreferred, you may want to talk to your doctor about a lower-cost option.

Prescriptions and pharmacies

Q: How do I find a participating retail pharmacy?
A: You can log on to Express-Scripts.com to find a participating retail pharmacy in the Express Scripts network near you. All participating retail pharmacies will accept your member ID card and are eager to serve your pharmacy needs. You can also find a participating retail pharmacy near you by calling Member Services toll-free at 877-621-8792

Q: How much medication can I receive per prescription?
A: You may receive up to a 30-day supply of medication from a participating retail pharmacy. However, for a medication you take on a long-term basis (such as those used to treat high blood pressure or high cholesterol), you should ask your doctor to prescribe up to a 90-day supply, plus refills for up to 1 year (as appropriate), to be filled through Express Scripts home delivery.

Also, many home delivery prescriptions can be refilled automatically through the Express Scripts Worry-Free Fills program. After you enroll a prescription in Worry-Free Fills, we will automatically send the next refill when you near the end of your current home delivery supply. You won't have to call or click to request it. Simply visit Express Scripts to enroll your eligible prescriptions in the Worry-Free Fills program.

Website and mobile app

Q: How do I register with the Express Scripts website?
A: Visit Express-Scripts.com and click the “Create online account” button. You will be asked to provide your Express Scripts member ID number and email address.

Q: What can I do on the Express Scripts website?
A: You can visit Express-Scripts.com to get information about your plan, find participating retail pharmacies near you and see how much certain medications will cost. In addition, you are able to visit Express-Scripts.com to quickly refill home delivery prescriptions online, check order status, receive timely medication alerts, find potential lower-cost options available under your plan and ask questions of a pharmacist online.

Q: How do I download the Express Scripts Mobile App?
A: Visit your mobile device’s app store and search for “Express Scripts” to download and use it for free.

Q: What can I do on the Express Scripts Mobile App? A: You can use the app to view and refill your medications, check order status, and set reminders for when to take them or to notify you when you are running low. You can also get personalized alerts, check for lower-cost prescription options available under your plan and display a virtual member ID card that you can use at the pharmacy.

Specialty medications

Q: Can I order all my medications from Accredo?
A: No. Accredo is part of your prescription drug benefit.

Q: Is there an extra cost to use Accredo’s services?
A: No. Accredo dispenses only specialty medications.

Q: Can I get a 90 Day Supply for my Specialty Medication?
A: No. Most Specialty Medications are limited to a 30 day Supply. Some particular medications may have more stringent restrictions.

Preferred drugs and your plan’s coverage

Q: How do I know whether my medication is covered or whether there is a generic equivalent?
A: When you fill a prescription at a participating retail pharmacy or through the Express Scripts Pharmacy home delivery service, you will be notified if your plan does not cover your medication. You can log on to Express-Scripts.com to find coverage and pricing details online, and to find out whether your medication has a generic equivalent. Or you can call Member Services toll-free at 877-621-8792.

Q: Are generics safe?
A: Yes. FDA approved generic drugs, like brand-name drugs, must meet established FDA standards of quality and purity to help ensure their safety and effectiveness, and they usually cost less. Generic versions have the same active ingredients as their brand-name counterparts, and they are equal in strength and dosage. Sometimes drug manufacturers use different inactive ingredients, such as fillers and dyes, which affect a drugs shape, color, size or taste.

Q: Why should I consider generics or preferred brand-name drugs?
A: You may save money by taking generics or preferred brand-name drugs because they usually cost less under your plan than non-preferred brand-name drugs. Many new generics have become available over the past year. If you’re taking a non-preferred drug, check your copayments and then ask your doctor whether a lower-cost option would be right for you.

Q: What is a coverage review or prior authorization?
A: LEHB uses coverage management programs to help ensure you receive the prescription drugs you need at a reasonable cost. Coverage management programs include prior authorization, step therapy and quantity duration. Each program is administered by Express Scripts to determine whether your use of certain medications meets your plan’s conditions of coverage. In some cases, a coverage review may be necessary to determine whether a prescription can be covered under your plan.

If your prescription requires prior authorization, you or your doctor can initiate the prior authorization review by calling Express Scripts at 800.753.2851. Express Scripts will inform you and your doctor in writing of the coverage decision.

Q: Can I find out ahead of time if a medication may need a coverage review?
A: Yes. You can log on to Express Scripts and use the “Price a medication” feature, found under the ‘Manage Prescriptions.” After you look up a medication’s name, click “View coverage notes.” Or you can call Member Services at 877-621-8792.

Q: Can I find out ahead of time if a medication may need a coverage review?
A: Yes. You can log on to Express Scripts and use the "Price a medication" feature, found under the "Manage Prescriptions." After you look up a medication's name, click "View coverage notes." Or you can call Member Services at 877-621-8792.

Miscellaneous

Q: What is a specialist pharmacist?
A: Express Scripts specialist pharmacists have specialized training in the medications used to treat a specific condition, such as high cholesterol, high blood pressure, depression, diabetes, asthma, osteoporosis and cancer. They’re available by phone to answer any medication questions. They’ll help you understand the common side effects of your medications, including some of which you may not be aware. 800-803-2523.

Q: How can I get a new member ID card?
A: Request a new card by calling Member Services at 877-621-8792. You can also visit Express-Scripts.com and, after registering or logging in, select "Print and Request Cards" from the drop-down menu under “Health & Benefits Information." Then select "Print a temporary prescription card." You can use your temporary member ID card until you receive your permanent card. Also, if you download the Express Scripts Mobile App to your mobile device, you’ll be able to display your Express Scripts ID card anytime.

Q: I am going on vacation. Can I get an additional supply of medication?
A: Yes. To receive an extended supply of medication, call LEHB at 215-763-8290.

Q: Can I receive a 1-year supply of medication if I am traveling overseas?
A: Yes. You may receive a 1-year supply of medication from Express Scripts as long as it is indicated on your prescription. You will be responsible for the copayment associated with a 1-year supply. There are some limitations with controlled or temperature sensitive medications. For more information, call Member Services at 877-621-8792.