Using Express Scripts Mail Order

Express Scripts mail-order is a convenient way to get your prescription drugs delivered to your home and ensure you stay adherent to your medication by planning in advance. You will also receive reduced copays for getting a 90-day supply via mail-order rather than purchasing a 60-day supply at retail for eligible drugs.

Benefits of Using Mail-Order Services

One of the greatest problems associated with maintenance medications is adherence. Maintenance drugs are medications prescribed for chronic, long-term conditions that are taken on a regular, recurring basis. Using a mail-order service to refill your maintenance prescriptions is a convenient way to ensure you have enough of the medication delivered directly to your home. Express Scripts mail-order service provides the following benefits:

  • Get up to a 90-day supply of each covered medication for a lower co-payment – two copays rather than three (subject to plan limitations, rules, and state regulations, such as controlled substances).
  • Registered pharmacists are available 24 hours a day, 7 days a week.
  • Order refills online, by mail, or by phone – anytime day or night. To order online, register at www.express-scripts.com. Refills are usually delivered within 8 days after Express Scripts receives your order.
  • Choose a convenient payment option – check, money order, credit card, or Express Scripts automatic payment program
  • Automatic Refills
  • Standard shipping is free

Submitting a Prescription through Mail Order

Your 90-day mail-order prescription should be sent to:

Express Scripts, Inc. P.O. Box 650322 Dallas, Texas 75265-0322

Or, you may ask your doctor to call 1-888-327-9791 for instructions on how to fax the prescription to Express Scripts (ESI). Your doctor will need to use your social security number or ESI member ID number to complete the transaction. (Only doctors can fax prescriptions to ESI.)

Order Delivery Times

First-time orders arrive within 8 to 11 days. Refills usually arrive in less time – 7 to 9 days, however, you can call to request expedited delivery. At www.express-scipts.com you can review detailed order status information. The best time to reorder is when you have about a 14-day supply of your medication remaining. This will help ensure that the medication is received when it is needed.

Express Scripts Value-Added Programs

Express Scripts, the prescription drug provider for the A&M Care plans, has several value-added programs. These, and other Express Scripts programs, can be found on the System Benefits Administration website at https://www.tamus.edu/business/benefits-administration/prescriptions-express-scripts/.

Pulmonary Care Value Program

Express Scripts (ESI) created the Pulmonary Care Value (PCV) program to improve adherence since a large majority of asthma patients fail to take their medication as directed.

  • Patients must fill all pulmonary care maintenance medications as 90-day prescriptions from Walgreens, home delivery, or certain other local pharmacies. Express Scripts provides access to one-on-one support from a team of extensively trained clinicians through their Pulmonary Therapeutic Resource CenterSM (TRC).
  • High-risk patients will be offered remote monitoring devices to help optimize medication use and maximize their health. When monitoring shows that patients overuse their rescue inhalers or are not adherent to controller medications, pulmonary TRC pharmacists will reach out with individualized support.
  • Some members will also be offered the Mango Health app – a patient engagement solution that gamifies health and rewards patients for making healthy decisions

 

Diabetes Care Value Program

The Diabetes Care Value Program combines a quality-based pharmacy network and a holistic approach to diabetes patient care. The program applies to all A&M Care health plan members who purchase oral and injectable diabetes drugs as well as the diabetes blood glucose test strips. The program requires that:

  • diabetes-related prescriptions be filled with a 90-day supply rather than a 30-day supply, and
  • diabetes-related prescriptions be filled through Express Scripts Home Delivery (mail-order) or a Walgreens pharmacy (retail).

The two main goals of the program are better patient adherence to diabetes medications and control of rapidly increasing costs. Aside from specialty medications used to treat debilitating diseases such as multiple sclerosis or HIV, spending on diabetic medications is the next highest spend. Controlling health plan costs helps offset premium increases and benefit reductions.

It’s Easier than Ever to get Vaccinated for the Flu and Other Illnesses

It’s Easier than Ever to get Vaccinated for the Flu and Other Illnesses

Vaccinations are now available at many convenient retail pharmacies.

Did you know that adults with the flu can be contagious from the day before symptoms begin (typically 1-4 days), all the way up to 10 days after the illness starts1 and can spread the flu to others who are sitting up to six feet away2? And to top it off, one-quarter of Americans show up to work despite not feeling well.3

One of the best ways to avoid the flu and related complications is to get a flu shot. According to the Centers for Disease Control and Prevention (CDC), every year in the U.S. 200,000 Americans are hospitalized because of problems related to the flu4, and the single best way to prevent seasonal flu is to get vaccinated each year. CDC recommends a yearly flu vaccine for everyone 6 months of age and older.

To help you stay healthy, you can now receive vaccines administered at your local retail pharmacy, covered at 100%, through your A&M System prescription-drug benefit. These typically do not require an appointment and are the same effective medications as those from your physician’s office.

Along with protection from the flu, your prescription-drug benefit plan covers several other vaccines, which can be administered by pharmacists at participating network pharmacies:

  • Flu (seasonal influenza)
  • Tetanus/Diphtheria/Pertussis
  • Hepatitis
  • Human Papillomavirus (HPV)
  • Meningitis
  • Pneumonia
  • Shingles/Zoster
  • Travel Vaccines (rabies, typhoid, yellow fever, etc.)
  • Childhood Vaccines (MMR, etc.)

There are two ways to locate a participating pharmacy:

  1. Sign in at Express-Scripts.com and click Prescriptions, then Find a Pharmacy to search for in-network pharmacies convenient for you.
  2. Call the number on your Express Scripts member ID card to find a participating pharmacy near you.

Contact your network pharmacy in advance to inquire about vaccine availability, age restrictions, and current vaccination schedules. Also, don’t forget to present your member ID card to the pharmacist.

Are there other ways to prevent the spread of illness?

According to the CDC, everyday actions can help you stay healthy:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub such as Germ-X® or Purell®.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.
  • Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

1,4 WebMD: https://wb.md/2FmTI80

2,3 Newsweek: https://bit.ly/2o1CUvC

Diabetes Patient Assurance Plan

Diabetes Patient Assurance Plan

Did you know that many people with diabetes have to ration their insulin because they can’t afford to take it as directed? That’s why the A&M System and Express Scripts have partnered to bring down the cost of preferred insulin products for you and your family members living with diabetes.

Through the new Patient Assurance Program, eligible members will never pay more than $25 per 30-day supply of preferred formulary insulin products. That can mean more affordable access to insulin and fewer health emergencies. It’s already included in your benefit – so there’s no additional fee! Mail-order participants will continue to pay the standard, lower copay.

Questions about the Patient Assurance Program or your benefits? Contact Human Resources or  Express Scripts at 1-866-544-6970 for more information or details about preferred medications.

Using Your Benefits While Traveling

Using Your Benefits While Traveling

Using Your Benefits While Traveling

The holidays are approaching and this is the most popular time of year for employees to travel. Make sure you are covered if you need medical care while traveling.

First– Save all of your information

Do you know your Group Number and Insurance ID by heart? No? That’s okay. The MyEvive app lets you save space in your carry-on and upload your insurance ID cards to your phone! Download it using the Employer Name: Texas A&M University System.

Medical and Prescription Drug

You should keep a list of your emergency contacts on hand, and save the Blue Cross and Blue Shield BlueCard customer service number: 1-866-265-1212. A Benefits Value Advisor can help you find in-network services in the region you are traveling. The BlueCard Program* helps Blue Cross and Blue Shield of Texas (BCBSTX) members get needed health care when you travel outside your plan service area.

If you need a prescription drug supply for a period longer than 30 but less than 90 days, have your physician write a prescription for the needed dosage and send it directly to Express Scripts (ESI) with one mail-order copayment (twice the retail pharmacy copayment).

  • Your 90-day mail-order prescription should be sent to:
    Express Scripts, Inc.
    P.O. Box 650322
    Dallas, Texas 75265-0322

Or, you may ask your doctor to call 1 888 327-9791 for instructions on how to fax the prescription to Express Scripts. Your doctor will need to use your social security number or ESI member ID number to complete the transaction. (Only doctors can fax prescriptions to ESI.)

If you have more than one prescription filled, send one copayment for each prescription. Be sure to start this process at least three weeks before your departure date. First-time orders arrive within 8 to 11 days. Refills usually arrive in less time – 7 to 9 days. The best time to reorder is when you have about a 14-day supply of your medication remaining. This will help ensure that the medication is received when it is needed.

Vision

The only thing worse than getting sick while traveling is losing your contact lenses. Pack at least two extra pairs of contact lenses while traveling so you have replacements. To locate a network provider in the area in which you will be traveling, or to get information on how the plan handles claims for services you receive while traveling, contact Superior Vision at (844) 549-2603.

Dental

Within the United States, you may use any licensed dentist for covered services. Generally, you will pay less out-of-pocket by using a PPO network. Delta Dental’s National Dentist Directory is online at www.deltadentalins.com.

*The BlueCard Program is not available for Medicaid and Medicare Advantage members

Express Scripts Updates and Medicare Notice

Express Scripts Updates and Medicare Notice

Express Scripts Updates and Medicare Notice

Opioid Management

The Opioid Epidemic was brought on by alarming opioid-related statistics in recent years. In 2016 alone, 115 people died each day from a prescription pain killer overdose. Several prescriptions drug companies have implemented drug abuse regulation programs to combat the epidemic. Express Scripts, the A&M System’s prescription drug insurance provider, has been nationally recognized for its active fight against opioid abuse.

In response to the epidemic, restrictions are in place for the purchase and use of opioid medications through the prescription drug plan. As of September 1, Express Scripts (ESI) has added the following conditions to its Opioid Management program:

  • Adults beginning opioid therapy are limited to a 7-day supply for each of their first four fills, and require a Prior Authorization (PA) to exceed 28-days’ supply in a 60-day period.
  • Pediatric patients’ opioid therapy is limited to a 3-day supply for each of their first four fills and will require a PA to exceed 12-days’ supply in a 60-day period.
  • Prior authorization is required for members starting on opioids who accumulate a daily morphine- equivalent dose greater than 90MME.
  • Existing opioid users will continue to be limited to 200MME without a prior authorization
  • Attestation of treatment plan or pain contract and assessment of co-prescribing of naloxone is required to exceed 200MME
    • Additional documentation is required to exceed 600MME
  • New Physician Care Alerts
    • Alert when patient with a mental health prescription is prescribed an opioid
    • Alert when patient with a prenatal vitamin prescription is prescribed an opioid
  • New Patient Support
    • Outbound phone calls from ESI’s Therapeutic Resource CenterSM (TRC) pharmacists to support members on Medication-Assisted Therapy
  • Bringing additional awareness to patients by providing suicide, mental health and addiction hotline resources for members needing someone to talk to on select member-facing materials

 

How Automatic Refills Work with Express Scripts

When enrolling an eligible prescription into the Express Scripts Automatic Refill program, the patient is given a standard 18-day buffer before the initial automatic refill. This allows enough processing and mailing time.  From that point on, the prescription will auto-refill exactly every 90 days.

The patient will receive a phone call/email 7 days prior to the refill to remind them of the next auto-refill.  They should have a ~25 day supply on-hand at time of notification and have the option to postpone the fill or let it be filled and sent.

Often, this can be perceived to the participant as receiving a refill “too soon” or “sooner than needed”. For this reason, the number of buffer days can be adjusted by the patient online or by calling Express Scripts customer service. The member may also discontinue the automatic refill at any time and go back to doing the refills themselves,  online or by phone.  If automatic refills are reinstated, the process will return to the initial 18-day buffer which may be seen as a delay. Keep this in mind as you are setting your automatic refills.

Medications excluded from the automatic refill program commonly fall under the following criteria:

  • All controlled substances or medications with legal restrictions or supply limitations
  • All specialty medications
  • Medications that are not indicated for chronic or maintenance use
  • Medications that often require frequent dose changes (e.g. chemotherapy medications)
  • Medications typically prescribed on an as needed basis (e.g. pain and migraine medications)
  • Medications where lack of specific dosing and use make it difficult to know when refills are needed (e.g. topicals)
  • Injectable medications (excluding diabetes medications)
  • Medications written with less than a 2 month supply

 

Medicare Part D – Annual Notification

As a participant of the A&M Care 65 Plus plan, you are enrolled in the Medicare Part D Prescription Drug Program. Each year, Medicare sends an annual notification of enrollment and a quick reference guide which provide valuable information about your Medicare coverage. Expect to receive this packet around the end of November . You do not need to take any action upon receipt of these materials, simply keep them for your records. If you have questions about your Medicare Part D plan, visit the A&M System Benefits website, and review the Retiree Benefits page or call Express Scripts Medicare at 1-855-895-4647.