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About your prescription plan

Prescription plan highlights

Where can I find a summary of my prescription plan?
"Benefit highlights" is a summary of your pharmacy benefit as provided by your health plan's prescription drug program, administered by Express Scripts. This at-a-glance overview shows when to use a participating retail pharmacy, and when it is recommended that you take advantage of the convenience of home delivery. "Benefit highlights" also displays the days' supply, co-pay, deductible and out-of-pocket expenses associated with using your prescription benefit plan. Once logged in, you can access your "Benefit highlights" from the left-hand menu bar in the "Prescriptions & benefits" section.

How should my doctor write my home delivery prescription?
To maximize your savings:

  • Ask your doctor to write your prescription for a 90-day supply (or your plan's home delivery limit) with refills when appropriate instead of 30-day supply with refills.
  • It is important to ask for a 90-day supply, as opposed to a 30-day supply, in order to receive up to 90 days of medication for one home delivery co-payment. Please note that you will be charged a home delivery co-payment regardless of the number of days' supply written on the prescription, so make sure your doctor has written the prescription for 90 days.

Please note that the actual quantity and/or days' supply may vary for each drug. Your doctor's instructions on how to take the medication, state and federal dispensing guidelines, or how the medication is packaged may impact the quantity and/or days' supply you can receive.

What does "days' supply" mean?
Days' supply refers to the number of days of medication your physician prescribes. In most cases, your physician will prescribe a 30-day supply when using a participating retail pharmacy. For ongoing prescriptions, you can tell your physician that you would like to use our home delivery pharmacy and ask your physician to write your prescription for the maximum days supply permitted by your plan. Note that while each plan differs, most plans' maximum days supply when taking advantage of home delivery is 90 days.

What is a co-payment?
A co-payment (co-pay) is the portion of the total cost of the prescription that you must pay. Co-payments differ depending on your plan's coverage and guidelines and are necessary for new prescriptions, prescription refills and prescription renewals.

What is a deductible?
A deductible is the amount of covered charges you must assume/pay before your health plan provider will permit your insurance benefits to be paid.

What is an out-of-pocket expense?
An out-of-pocket expense is the amount that a covered person must pay out of their own pocket, regardless of one's coverage.

Are there any differences in my benefits when using home delivery versus a participating retail pharmacy?
If your benefit plan has a home delivery component, having a larger days supply, such as a 90-day supply when using home delivery, increases your convenience by shipping medications to your door and by providing you the ability to use our site to refill and renew your prescriptions online, anytime, once you get started. Depending on your plan's guidelines, taking advantage of your home delivery benefit could save you money. Check your plan's specifics for details.

What if I've reviewed the information that you have displayed in "Benefit highlights" and they seem to be different from what I thought they were?
Always check your plan's benefit materials should you need more details or have questions. If you still need assistance, you can use our online form to contact a member services representative or call toll-free for more information.

How can I locate a participating retail pharmacy in my area?
Once logged in, you can locate a participating retail pharmacy in your area by clicking the "Locate a pharmacy" link located in the left-hand menu bar in the "Prescriptions & benefits" section. Next, follow the on-screen instructions to enter a location using either a valid ZIP code or the city and state. When entering the city and state please be sure to include a comma between the city name and the state abbreviation.

What if I was unable to use my drug ID card to purchase a prescription at a participating retail pharmacy?
If your benefit plan allows, you can submit a claim for reimbursement. Your reimbursement claim will be considered based on what your plan approves. You may submit a "Prescription Drug Reimbursement Form" if you have paid full price for a prescription drug order at a pharmacy because:

  • The pharmacy does not accept your prescription drug ID card
  • You have not received your prescription drug ID card
  • Your benefit plan requires you to submit a claim form for all your participating retail pharmacy purchases
The "Prescription Drug Reimbursement Form" may be found on the Forms & Cards page.


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