Compass Rose
Health Plan

Your partner in health

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Prescription Drug Program

 

Our Prescription Drug Plan is provided through Express Scripts utilizing their National Preferred Formulary, a list of generic and brand name prescription drugs covered under our plan.

Express Scripts ensures that you have access to high-quality, cost-effective medications through a network of retail pharmacies and by convenient home delivery. Prescription drug copayments are split into tiers:


Level IN-NETWORK RETAIL PHARMACY
(30-DAY SUPPLY)
HOME DELIVERY
MAIL-ORDER 
(90-DAY SUPPLY)
TIER 1 
(GENERICS)
$5 co-pay* $10 co-pay*
TIER 2 (FORMULARY/
PREFERRED BRAND NAME)          
$35 co-pay* $70 co-pay*
TIER 3 
(NON-FORMULARY/
NON-PREFERRED 
BRAND NAME)
$50 co-pay or 30%,
whichever is greater*
$100 co-pay or 30%,
whichever is greater*           

SPECIALTY PHARMACY IN-NETWORK RETAIL PHARMACY
HOME DELIVERY
MAIL-ORDER 
(30-DAY SUPPLY)
GENERICS
N/A 20% up to a maximum of $150*
FORMULARY/
PREFERRED BRAND NAME         
N/A 20% up to a maximum of $200*
NON-FORMULARY/
NON-PREFERRED 
BRAND NAME
N/A 25% up to a maximum of $300* 

* No deductible applied.

Filling Prescriptions

 

When it comes to getting prescriptions filled, Compass Rose Health Plan members have options. There are two ways to obtain the prescriptions you need.

  1. Through a local network retail pharmacy
  2. Through Express Scripts Home Delivery in the case of maintenance drugs (drugs prescribed for at least 90 days, up to one year)

With the Home Delivery Program, members receive a three-month supply of their prescription for the cost of two months. Your order can be submitted several ways:

ONLINE:
The easiest way to enjoy the convenience of Home Delivery is to ask your provider to send your prescription(s) electronically to the Express Scripts Pharmacy℠. The prescription should be written for at least a 90-day supply (with refills up to one year).


BY MAIL:
Mail in a prescription your provider has written following these steps:

  1. Ask your doctor to write your prescription for up to a 90-day supply of your medication, plus refills for up to one year
  2. Complete a Home Delivery Order Form
  3. Return the completed order form, the written prescription and payment to:
    Express Scripts
    P.O. Box 66577
    St Louis, MO 63166-6577

Your provider can also fax your completed order form to Express Scripts. Have them call (888) 327-9791 for instructions on how to fax your prescription. Your provider will need your member ID number. Faxes must be sent from your provider's office. Faxes sent from other locations, such as your home or workplace, will not be accepted. Express Scripts cannot accept controlled substance prescriptions by fax — prescriptions for these medications MUST be mailed.

Your medication will be mailed to your home via standard U.S. Postal Service delivery at no charge. Orders are usually processed and mailed within 48 hours of receipt. Please allow 2-3 weeks for delivery after mailing in the completed form and prescription. Your medication will arrive in a plain, weather- and tamper-proof pouch with packaging accommodations made for temperature control if needed.

Specialty Medications

 

Medications used to treat severe and/or chronic medical conditions — usually administered by injections or infusions — may be subject to the Specialty Pharmacy Benefit administered by Accredo. Please refer to our formulary to determine if the drug you have been prescribed by your physician needs to be filled by our Specialty Pharmacy.

If your medication has been identified as being a specialty medication, you will be required to call Express Scripts for instructions on how to arrange the filling and delivery of your prescription. Medications will be mailed to you at no additional cost and, for safety, all mailing will be shipped based on temperature requirements and considerations.

Note: Specialty medications are not eligible for the home delivery benefit of a three months’ supply for the cost of two months.

Please contact Accredo at (800) 803-2523 for more information.

Prior Authorization

 

Members must get prior authorization for certain medications, which must be renewed periodically. Some of these medications may be covered with limits, provided that you receive approval through a coverage review. Examples of drug categories requiring prior authorization include, but are not limited to, growth hormones, interferons, erythroid stimulants and oncologic agents. During this review, Express Scripts will ask your doctor for more information than what is on the prescription before the medication may be covered under the Plan.

This extra screening protects you or your family members by making sure the medication is safe for you and prescribed at the right dosage. Prior authorization helps you avoid taking a medication that could have adverse effects on your health. It also reduces costs associated with inappropriate medication use.

Additional examples of when prior authorization may be required:

  • Medications with age or gender limitations
  • Medications prescribed for a quantity exceeding normal limits
  • A more effective alternative may exist

If your prescription needs prior authorization, your pharmacist will make a request to your provider. Only your provider can submit this information.

If you submit a prescription for a medication that has quantity limits, your pharmacist can dispense up to the allowable amount. Approval is needed before additional quantities can be filled. Unless your doctor obtains approval, you will be responsible for the cost of the medication that exceeds the quantity allowed by your Plan. Express Scripts will notify you and your doctor of the decision.

To find out what drugs require prior authorization or have quantity limits, call Express Scripts’ prior authorization number (800) 753-2851.

Online Access

 

Compass Rose Health Plan members can access their prescription drug information through their Member Portal Account to:

  • Find local pharmacies
  • Enroll in Home Delivery
  • Check benefits and coverage
  • Price a medication
  • View drug interactions
  • Access cost-saving tools
  • And much more!

INFORMATION & FORMS

  • Express Scripts Formulary

    See a list of preferred medications and exclusions in our prescription drug program.


  • Home Delivery Order Form

    Enroll in Home Delivery by completing this form and mailing it in with your prescription.


  • Express Scripts Claim Form

    To receive reimbursement for prescription drugs follow the instructions on this form.

    • See a list of preferred medications and exclusions in our prescription drug program.

    • Enroll in Home Delivery by completing this form and mailing it in with your prescription.

    • To receive reimbursement for prescription drugs follow the instructions on this form.

 


Price A Medication

Find out how much you can expect to pay for your medications under the Compass Rose Health Plan.


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