Express Scripts, Inc. (ESI) manages the prescription drug benefits for FCPS employees in the Aetna/Innovation Health and CareFirst BlueChoice Advantage plans.
The ESI plan contains several quality assurance programs to ensure you receive the most appropriate medication at the lowest cost. These programs include:
Prior Authorization- Some drugs require proof of medical necessity before the plan will pay for a prescription. The purpose of prior authorization is to prevent misuse and the off-label use of expensive and potentially dangerous drugs. This list of drugs requiring prior authorization can be found on the Express Scripts Express Preview page.
Preferred Home Delivery Program-Home delivery is available for prescriptions used on a regular basis, such as those for chronic conditions like arthritis or high blood pressure. These “maintenance” medications are usually taken for more than two months. The Preferred Home Delivery program provides you the lowest copay; you can receive a 90 day supply of maintenance medications for two copayments. This program also saves you from paying “ancillary charges” - additional fees you must pay upon the third fill of a maintenance medication at your local pharmacy.
Generics Preferred Program-Generic drugs are copies of brand-name drugs whose patent has expired. Generic drugs are just as safe and effective as brand-name drugs, but much less expensive. Under the Generics Preferred program, the pharmacy will fill your prescription with generic medications, unless your doctor has stated that you must take the brand name drug. If your doctor documents a medical need to use a brand-name drug instead of its generic equivalent, you will pay only the generic drug copayment for the brand-name drug if ESI concurs with your doctor’s assessment.
Step Therapy–The Step Therapy program assures that you get the most affordable treatment while keeping safety and cost in mind. With step therapy, you typically start with a generic drug before a brand name drug is approved. If you are not able to use the generic drug, brand name drugs are covered in the second step.
Specialty Medications-Specialty oral or injectable medications are provided through CuraScript Accredo.
571-423-3000 or 1-800-831-4331
January 14, 2014