Filling Prescriptions

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

1. Through a local network retail pharmacy
2. Through a Smart90 retail pharmacy like CVS or Walgreens
3. Through Express Scripts Home Delivery in the case of maintenance drugs (drugs prescribed for at least a three-month supply, up to one year)

With the Home Delivery Program AND at a Smart90 pharmacy, members receive a three-month supply of their prescription for the cost of two months.

Using Home Delivery

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 three-month 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.

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.

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 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.