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.
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.
571-423-3000 or 1-800-831-4331
July 7, 2014