Express Scripts (Aetna/Innovation Health and CareFirst)

 

Express Scripts, Inc. (ESI) manages the prescription drug benefits for FCPS employees in the Aetna/Innovation Health and CareFirst BlueChoice Advantage plans.

  • Network includes 56,000 participating pharmacies (both major chains and independent pharmacies), a specialty pharmacy, and a mail-service pharmacy.
  • Your copayment is 20 percent of the cost of the drug, subject to certain minimum and maximum amounts.
  • Maximum annual out-of-pocket limit is $1,500 for an individual and $3,000 for a family.
  • Going on vacation? You can fill your next month’s prescription early with “vacation override”.
  • See the cost of your medications before you order by using Price Check, an online feature of express-scripts.com.
  • Automated refill reminders are available.

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.

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 Accredo, ESI's specialty pharmacy.

Other Programs:

Express Scripts Medicare

Express Scripts Contact

www.express-scripts.com
1-866-815-0003
24 hours/7 days/week
Find a Participating Provider

 

Other Resources

For all HR questions contact

HRQuestions@FCPS.edu
571-423-3000 or 1-800-831-4331

Webpage Curator

Lori Carpenter
lacarpenter@fcps.edu

Last Updated

July 7, 2014