Exclusive Home Delivery
Your Exclusive Home Delivery Program pertains to maintenance medications, or prescription drugs for ongoing conditions such as diabetes or high blood pressure. Under the program, you can get up to a 1-month supply of a maintenance medication two times from a local participating pharmacy. After that, PSSU
Health and Welfare Fund will cover the medication only if you order it from the Express Scripts Pharmacy.
By using the Express Scripts Pharmacy, you’ll save money on your copayments for maintenance medications.
Plus, you’ll receive:
• Free home delivery of your medication.
• Up to a 3-month supply of medication with each order.
• 24-hour access to a pharmacist.
FREQUENTLY ASKED QUESTIONS
About Your Exclusive Home Delivery Program
1. Why can’t I fill my prescription at my local pharmacy?
PSSU Health and Welfare Fund now provides coverage of maintenance medications through an Exclusive Home Delivery Program. This program helps you get maintenance medications in a reliable, convenient way while keeping your plan’s costs down.
A maintenance medication is a prescription drug that treats an ongoing condition such as diabetes or high blood pressure. Under your Exclusive Home Delivery Program, you can get up to a 1-month supply of a maintenance medication two times from a local participating pharmacy. After that, PSSU Health and Welfare Fund will cover the medication only if you order it from the Express Scripts Pharmacy.
2. Aren’t most drugs “maintenance medications”?
Not necessarily. Many drugs are for short-term conditions. For example, your doctor might prescribe a 15-day medication for an infection. You should always get these types of medications from a local participating pharmacy.
Maintenance medications are prescription drugs that you need to take regularly. Drugs that treat ongoing conditions like diabetes, high blood pressure and asthma are usually considered maintenance medications.
A maintenance medication can also be a drug that you take for 3-6 months and then discontinue. For example, an allergy medication that you take throughout the spring and summer could be considered a maintenance medication.
To find out if a specific drug is considered a maintenance medication by your plan sponsor, please call Express Scripts using the toll-free number on your member ID card.
3. Does this mean my prescriptions are not covered anymore?
No, it just means that PSSU Health and Welfare Fund will cover only two 1-month supplies from a local participating pharmacy. After you’ve used these two 1-month supplies, you will need to order the medication from the Express Scripts Pharmacy to receive coverage.
4. Why didn’t I know about this before I got to the pharmacy?
If you recently began taking a maintenance medication, you may not have realized that your benefit requires that you obtain maintenance medications from the Express Scripts Pharmacy.
If you’re already taking a maintenance medication, you’ll receive a letter a few weeks before your Exclusive Home Delivery Program begins. This letter will:
·Explain how your benefit is changing. ·Identify any of your current prescriptions that may be affected. ·Inform you that PSSU Health and Welfare Fund will cover only two more fills of these medications from your local pharmacy. After that, PSSU Health and Welfare Fund will cover the medications only if you order them from the Express Scripts Pharmacy.
The letter also explains the benefits of the Express Scripts Pharmacy and includes a form you can use to order your maintenance medications.
5. How does the Express Scripts Pharmacy work?
The Express Scripts Pharmacy specializes in helping patients save time and money. Last year alone the Express Scripts Pharmacy filled more than 38 million prescriptions for maintenance medications.
Every prescription is filled and delivered using a safe, reliable process. For example:
·Two registered pharmacists check every new prescription. ·Your medication is delivered in a plain, weather-resistant package. This protects the medication and ensures your privacy. ·You receive information about safety issues, side effects and drug interactions. ·Pharmacists are available 24 hours a day to answer your questions.
6. How do I start using Express Scripts?
There are two easy ways to start using the Express Scripts Pharmacy:
Visit www.express-scripts.com/getstarted and follow the instructions to get prescription home delivery. There are no forms to mail, no doctor visits to schedule. Just submit your request online, and the Express Scripts Pharmacy will do the rest.
A.Ask your doctor to write a prescription for up to a 90-day supply of your medication (plus refills for up to one year, if appropriate). B.Complete a Home Delivery Order Form. If you don’t have an order form, you can print one at www.express-scripts.com. Or simply request one by calling the toll-free number on your member ID card. C.Mail your order form and your prescription to the address on the form.
7. Why do I have to do all this work?
Actually, you only have to move your maintenance medication prescription to the Express Scripts Pharmacy one time. After that, it’s easy:
·Your prescription drugs are delivered to your home. ·You order refills just three times per year instead of every month. ·And you renew your prescription only once per year.
8. I don’t care about saving money. I want to get my prescriptions filled at my local pharmacy.
If you decide not to use the Express Scripts Pharmacy, you can still get your prescriptions filled at your local pharmacy, but your prescription will not be covered by PSSU Health and Welfare Fund. You’ll therefore need to pay the full cost of the drug.
9. I need to start taking this maintenance medication
immediately. What can I do?
At the start of the program, you can get up to a 1-month supply of your maintenance medication two times from a local participating pharmacy. You can also get any new maintenance medications that your doctor prescribes two times from a local participating pharmacy.
If you’ve already used these fills at your local pharmacy and still need an emergency supply of your maintenance medication, check with your pharmacist. He or she can usually provide a small supply of your prescription that you can use until you receive your order from the Express Scripts Pharmacy.
10. What other prescriptions should I fill through this benefit?
You should use the Express Scripts Pharmacy for all of your maintenance medications. To see which specific prescriptions you should fill through the Express Scripts Pharmacy, you can:
·Visit your prescription plan website, www.express-scripts.com. Just log on to your account and use the “Change to Mail Service” feature to switch your appropriate prescriptions. ·Call the number on the back of your member ID card. A patient care coordinator can quickly review your medications and tell you which ones you should fill through the Express Scripts Pharmacy. ·Refer to your benefit packet or talk to a PSSU Health and Welfare Fund benefit representative.
11. My doctor is “trying out” this medication with me, so I don’t know if I’ll be using it long-term. Do I still have to use the Express Scripts Pharmacy to fill this prescription?
No, not at first. The program is designed to let you and your doctor “try out” each new maintenance medication and decide if it’s a good long-term therapy for you. In fact, if you’re doctor is having you try different doses of the same drug, PSSU Health and Welfare Fund will cover each dosage up to two times from a local participating pharmacy.
After you have used your two fills from your local pharmacy, PSSU Health and Welfare Fund will cover additional fills only if you order them from the Express Scripts Pharmacy.