Pharmacy Benefits FAQs
Learn more about Express Scripts Home Delivery, Accredo Specialty Pharmacy, and prior authorization under the High Option Compass Rose Health Plan.There are three ways to sign up for Express Scripts 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 Fax: Your provider can 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.
Mail: Mail in a prescription your provider has written following these steps:
- Ask your doctor to write your prescription for up to a 90-day supply of your medication, plus refills for up to one year
- Complete a Home Delivery Order Form
- Return the completed order form, the written prescription and payment to:
Express Scripts
P.O. Box 66577
St Louis, MO 63166-6577
No, you do not need to pay for shipping. 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.
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 under the High Option plan. 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 Accredo 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.
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, your pharmacy benefit manager 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. Your pharmacy benefit manager will notify you and your doctor of the decision.
High Option Compass Rose Health Plan members can find out what drugs require prior authorization or have quantity limits by calling Express Scripts’ prior authorization number at (800) 753-2851.
