Prescription Drug Information
The medical plans cover prescription drugs. The BIN, PCN, and other prescription drug information is printed on the back of your Aetna medical card. Simply provide your Aetna id card at your local pharmacy, and they should be able to make the changes needed to transition your prescription benefit from Envision to Express Scripts.
July 1, 2017 was the first day of our new relationship with pharmacy benefits manager, Express-Scripts (ESI). Here are a few things you should know:
- The first time you fill a prescription, you must give the new pharmacy information to the pharmacist. They must have the new prescription plan information in order to run the prescription through the plan for you to obtain the medication at your copay amount.
- You should have received new id cards by now with the Express-Scripts information on the back. If you did not receive a new card, you can obtain one by calling the Aetna concierge at 1-800-905-7670 or by logging on to Aetna Navigator. In the mean time, you simply need to provide the pharmacist our new prescription plan information. The attachments below accurately depict what will be on your new card. The new customer service phone number to ESI is 1-800-363-9019. They can help you 24/7.
- If you use mail order, and have open, eligible refills, they have been transferred from Envision to Express-Scripts. Beginning July 1st, you should see them in your record on Express-Scripts.com once you have registered for the site. Customer service reps will be able to see them tomorrow, too. You can order refills either online, on the mobile app, or by calling a customer service representative at 1-800-363-9019.
- Please promptly open any mail you receive from ESI or Aetna in order to be fully informed.
- ESI will be doing outreach calls to members on specialty medications to facilitate a smooth transition. Please be sure to answer their call if they do reach out to you.
ESI is a Fortune 22 Company serving over 75 million Americans headquartered in St. Louis, Missouri. They pride themselves on innovation, being honored in 2015 for a second year in a row on Forbes List “World’s Most Innovative Companies”.
Your prescription drug benefit features a formulary drug list. A “formulary” is a list of medications organized into groups or “Tiers.”
|Formulary Tier Definitions|
|Tier One (1)||Most Generics|
|Tier Two (2)||Preferred (also called formulary) medications. These are on the preferred medications list.|
|Tier Three (3)||Non Preferred medications not on the preferred list|
|Tier Four (4)||Specialty Medications|
While our plan uses ESI’s National Preferred PSG (with Exclusions) as the basis for our tiers (http://lab.express-scripts.com/lab/insights/drug-options/2017-national-preferred-formulary), there are some exceptions. In addition, this list is not exhaustive. For the most accurate information about all coverage for your medications, please register (if you have not already), and log on to Express-Scripts.com. Use the “price a drug” tool to find out what tier your drug is, and how much it will cost you. Or if you prefer, call 1-800-363-9019 and a customer service representative can help you.
Copays and Coinsurance
Copays and coinsurance, the portion of the drug cost that you are responsible to pay, are listed for all of the Aetna plans in the table below. Please note the below reflects the cost-share that is effective July 1, 2017. You can view the 2017-2018 cost-share in the Benefits Booklet. The Aetna High Deductible Plan prescription drug plan covers prescriptions at the rates below after meeting the annual plan deductible for that plan year. There have been no changes to the pharmacy copays or coinsurance for FY 2018.
|30-Day Retail||90-Day Mail Order|
|Tier 1||Tier 2||Tier 3||Tier 4||Tier 1||Tier 2||Tier 3|
|Your Cost||$10.00||$40.00||$60.00||25% up to $150.00||$25.00||$100.00||$150.00|
The Express Scripts network includes over 65,000 retail location representing all major chains (such as CVS, Walgreen's, Kroger, HEB, Target, and Wal-Mart) as well as many independent pharmacies throughout the United States. Simply present your Aetna ID card (with Express Scripts information on the back of it) and your prescription to a participating pharmacy.
Benefits are available only through a network pharmacy. If your pharmacy is not in the network, you can submit a request to add that pharmacy to the network through the benefits department at email@example.com.
At the time of service, you must pay the required copayment (your portion of the cost of the medication) or if you are on teh High Deductible plan, your deductible and then your copayment. To access our Pharmacy Locator, please log into www.express-scripts.com and select "Find a Pharmacy" under the "Prescriptions" menu. You may also call the Express Scripts Customer Service at 1-800-363-9019.
Dispense as written requires that if a generic drug is available for your prescription, the prescription will be filled with the generic. If you request the brand, you will be charged both the difference in the actual cost of the generic and brand name drug, and the brand name copay. If it is medically necessary for you to use the brand name medication, your doctor may specify that request by 1. Writing for the brand name and 2. writing dispense as written. If these two criteria are met, you will pay the applicable brand copay only.
Maintenance drugs are medications prescribed for chronic, long-term conditions and are taken on a regular, recurring basis. Examples of chronic conditions that may require maintenance drugs are: high blood pressure, high cholesterol, and diabetes. Your pharmacist will inform you when the plan requires you to purchase your maintenance medication at 90 days.
For convenience, and so that you can be sure that your medication and dosage is appropriate for new prescriptions, you may fill a 30 day prescription up to two times at a retail pharmacy. Thereafter, maintenance medications must be filled using 90-day supplies. You can do this at a retail pharmacy or use the mail order program through Express Scripts. Be sure to ask your doctor for a 90 day prescription with the appropriate number of re-fills for your maintenance drugs.
We are pleased to provide mail order services through Express Scripts mail order.
Mail order is an excellent way to receive prescriptions you will be taking on a regular basis with no worries about availability of supply at the local pharmacy. In addition, mail order saves you money as you receive a 90-day supply for the price of a two and one half 30-day supplies. For individuals who are taking ongoing maintenance medications, you may want to consider utilizing the mail order service for the convenience of home or office delivery. When using mail order, shipping is free, it is easy to pay, and you can even set up an extended payment program to make paying for a 90-day supply even easier.
Please visit Express-Scripts.com for more information on mail order, or call them at 1-800-363-9019.
When you need a new prescription, your physician can write you one prescription for 90 days with 3 refills, and that will take care of you for the year. You can mail in that prescription with a mail order form available online at Express-Scripts.com or your doctor can e-scribe the prescription to Express Scripts or fax it to them. You must register at Express Scripts for the mail order, and give them your preferred method of payment.
If you have an active medication at the retail pharmacy, and want to transfer it to home delivery, simply register on Express-Scripts.com and follow the steps to "transfer to home delivery".
Specialty drugs are usually high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis. Specialty drugs often require special handling (like refrigeration during shipping) and administration (such as injection or infusion). Patients using a specialty drug often must be monitored closely to determine if the therapy is working and to watch for side effects.
Espress-Scripts uses Accredo Specialty Pharmacy as the exclusive provider for specialty medications as part of your prescription drug plan. What this means is that you and your family will receive the personalized care and expertise of Accredo's Specialty Pharmacy pharmacists, which is essential to successful prescription therapy. This is because Accredo Specialty Pharmacy goes beyond traditional retail pharmacy, helping you get the most from your specialty medication therapy.
Because specialty medications can be more difficult to manage, Accredo Specialty Pharmacy offers the following patient support services at no charge:
- Personalized support to help you achieve the best results from your prescribed therapy.
- Convenient delivery to your home or physician's office.
- Easy access to a team who can answer medication questions, provide educational materials about your condition, help you manage any potential medication side effects, and provide confidential support—all with one toll-free phone call.
- Assistance with your specialty medication refills.
- Specialty medications can be very expensive. If you find that your specialty medications are stretching your budget to the breaking point, your Accredo specialty pharmacist may have access to a copay assistance program to help you out. These programs are made available in certain circumstances by the drug manufacturer.
As a convenience, you can obtain two specialty prescription at any network pharmacy retail location. After that your second fill you will be required to use Costco Specialty Pharmacy for all of your specialty medication needs. You can access the Accredo specialty pharmacy the same way you access all other medications through Express-Scripts by logging on to Express-Scripts.com or by calling toll-free 1-800-363-9019.
Your prescription drug information can be found of the back of your Aetna ID card. Should you misplace your ID card and you need your covered prescriptions immediately, please take the following information (along with the Aetna temporary ID you can print when your log into Aetna Navigator) to the pharmacy and present it to the pharmacist:
- BIN: 003858
- PCN: A4
- Rx Group Number: RICEUNI
Should you have problems with your prescription claim, please ask the pharmacist to contact the Express Scripts Help Desk at 1-800-922-1557 or contact your Benefits Team.
How does the 90-day retail prescription drug program work?
The medical plan provides for purchase of 90-day maintenance prescriptions at retail pharmacies which accept Express Scripts coverage, which includes all of the major pharmacy and supermarket chains in the United States. You will pay for the 90 day prescription (at 2.5 times the 30 day cost) and receive the full 90-day supply in one transaction. As with a 30 day prescription, it is possible that the pharmacy may run out of a medication, but if that happens, they will send you home with the quantity they have in-stock, and you will be able to pick up the remainder of the order when the pharmacy re-stocks the medication, usually within a day or so. Both retail pharmacy and mail order services are available for you to fill your 90 day prescriptions.
Retail pharmacies will fill maintenance prescriptions of 30 days for two one-month cycles only; thereafter you must begin to purchase maintenance drugs in 90-day increments.
What is a maintenance medication? How will I know if I am required to get a 90 day supply?
Maintenance drugs are medications prescribed for chronic, long-term conditions and are taken on a regular, recurring basis. Examples of chronic conditions that may require maintenance drugs are: high blood pressure, high cholesterol, and diabetes. Your pharmacist will inform you when the plan requires you to purchase your maintenance medication at 90 days or you can call Express-Scripts at 1-800-363-9019, and they can tell you if your medication requires a 90 day fill.
Will certain drugs for chronic conditions still be covered at $0 copays, even though they are purchased for 90 days?
We happily did the math, and 2.5 times $0 is still $0. As part of our plan’s effort to help employees manage certain long-term medical conditions, certain generic drugs used to control high blood pressure, cholesterol, diabetes and asthma will continue to be available for the $0 copay.
Please explain Dispense As Written.
Rice's dispense as written requirement provides that if your physician writes for a brand drug and a generic is available, your prescription will be filled with the generic. If you request a brand drug instead of the generic, you will be charged both the difference in the actual cost of the generic and brand name drug, and the brand name copay. If your physician determines that it is medically necessary for you to use a brand drug, he or she can write a prescription that includes: 1) the brand name prescribed, and 2) direction to “dispense as written,” and you will be able to purchase the drug for the applicable brand copay.
Please contact us if you have other questions. Call 713-348-2363 (BENE) or email us at firstname.lastname@example.org.