1. health and fitness
2. drugs

How to fill a prescription
using Express Scripts
February 13, 2014
For Anthem members only
READ AND DELETE
For best results with this template,
use PowerPoint 2003
For Anthem members: How to fill a prescription using Express Scripts
Agenda
•
•
•
•
•
•
•
•
Benefits overview
Retail pharmacies
Mail-order drugs
Mandatory mail-order drug list
Filing a claim with Express Scripts
Out-of-pocket reimbursements
Tracking your deductible
Resources
For Anthem members: How to fill a prescription using Express Scripts
2
Benefits overview
Prescription Drugs
Deductible required
• Deductible required for retail or mail-order drugs
(Combined with medical deductible)
• $1,000 annual deductible for single coverage
• $2,000 annual deductible for family coverage
Retail Drugs
• You’re responsible for 15% of covered charges for
generic; 25% of brand medications
• Mandatory mail-order for maintenance drugs
• You can get the first three fills of the same prescription at a retail
pharmacy; no coverage for additional fills except through the
Express Scripts mail-order program
Mail-Order Drugs
(For drugs not on the free list)
• You’re responsible for 10% of covered charges for
generic; 20% for brand medications
• 90-day supply
For Anthem members: How to fill a prescription using Express Scripts
3
Benefits overview continued
Prescription Drugs
Generic Incentive
Provision
• If brand-name drug purchased when a generic is
available, you’ll be responsible for paying the price
difference plus any required coinsurance
• Any generic/brand price difference paid is a non-covered
expense and does not count toward your annual deductible or
out-of-pocket maximum
Free Prescription Drug
List
• Select drugs on the Free Mail-Order Drugs List are free,
no deductible required
• Free Mail-Order Drug List available at
www.mypgebenefits.com>Understanding Your Medical
Benefits>Understanding Your Prescription Drug Coverage> Drug
Coverage At A Glance
• In order for the drug to be free, you must use the Express Scripts
mail-order program
For Anthem members: How to fill a prescription using Express Scripts
4
Retail pharmacies
• You’ll need your Express
Scripts ID card and your YSA
Visa® debit card
• How to pay:
• Express Scripts pharmacies can
tell how much you owe under
the HAP
• Pay your share using your YSA
Visa® debit card as long as you
have enough credits in your
account
If you fill your prescription at a nonparticipating pharmacy:
•
: Pay 100% of the prescription
cost up-front using your own money
(cash, check, credit or debit card)
•
: Submit the bill to Express
Scripts and wait for the explanation of
benefits (EOB)
•
: File a claim with Your
Spending Account to be reimbursed for
your share of the bill
Step 1
Step 2
Step 3
For Anthem members: How to fill a prescription using Express Scripts
5
Mail-order drugs
• Using the Express Scripts mailorder pharmacy will cost you less
• Some prescription drugs are free
when you receive them in the
mail.
• Visit www.mypgebenefits.com
>Resources >Express Scripts
Resources>Express Scripts Free
Mail-Order Medication List
• Prescriptions that are not listed on
the free list are still covered by the
plan
• How to pay:
•Your YSA Visa® debit card can be
used to pay your share of the
prescription cost as long as you
have enough credits in your account
Visit www.express-scripts.com and
register your YSA Visa® debit card as the
primary payment card and your personal
credit or debit card as secondary
For Anthem members: How to fill a prescription using Express Scripts
6
Mandatory mail-order drug list
If a drug is on the mandatory mail-order list:
• After three fills at a retail pharmacy, you must get the drugs from
mail-order, or pay 100% of the costs
• Only for maintenance drugs
• Would not include drugs you take for a limited time, such as most
antibiotics and pain medication after a surgery
• Does apply to drugs that are used to treat many on-going, chronic
conditions, such as diabetes, high blood pressure, high cholesterol
• Certain drugs are not allowed to be sold mail-order and they are
exempt from mandatory mail order, such as some narcotic pain
medicines
• List is available on www.mypgebenefits.com>Using Your Medical
Benefits>Filling Prescriptions>Filling a prescription by mail (Anthem
HAP)
For Anthem members: How to fill a prescription using Express Scripts
7
Mandatory mail-order drug list continued
• You should have received information at home from Express
Scripts explaining the program with instructions on how to sign
up
• You may sign up by going to www.express-scripts.com or
calling Express Scripts at 1-800-718-6590
• Members filling prescriptions at retail pharmacies for drugs on
the mandatory mail-order list will receive personal reminders at
home from Express Scripts to sign up for mail-order to
continue your drug coverage
• Union-represented employees can receive up to three fills at a
retail pharmacy before signing up for mail-order refills in 2014
• Management and A&T employees, who moved to the new plan
in 2013, should have already transitioned their prescriptions to
mail-order
For Anthem members: How to fill a prescription using Express Scripts
8
Filing a claim with Express Scripts
• Visit www.express-scripts.com
>From home screen click on
“Health & Benefits Information” >
“Print & Request Forms & Cards”
(scroll down to claim forms)
• Express Scripts App available on
iTunes and Google Play app
stores:
• List of current medications
• Prescription ID card
• Refill and renew prescriptions
• Order status of prescriptions
• Locate an Express Scripts pharmacy
William Shakespeare
04/23/1616
• Call Express Scripts at
1-800-718-6590
•Representatives are available 24
hours a day, 7 days a week
For Anthem members: How to fill a prescription using Express Scripts
9
Out-of-pocket reimbursements
If you pay for health expenses out-ofpocket, you may submit your receipts to
be reimbursed:
• You may request a refund by:
• www.yourspendingaccount.com/pge
• Reimburse Me smartphone app available
on iTunes and Google Play app stores
• Calling Your Spending Account at
1-800-964-9902
• Representatives are available MondayFriday, 5 a.m.-5 p.m.
• You’ll need:
• A photocopy of your Explanation of
Benefits (EOB)
For Anthem members: How to fill a prescription using Express Scripts
10
Track your deductible
Deductible/Out-of-pocket
Maximum
Log on to your Anthem account:
• www.anthem.com/ca/pge
• Click the Claims tab at the top of the
home page
• Click Deductibles & Out-of-Pocket
Amounts
For Anthem members: How to fill a prescription using Express Scripts
11
Resources – Express Scripts
• Visit www.express-scripts.com
• Manage your prescriptions
• File a claim for reimbursement
• Track your prescription order status
• Express Scripts App available on
iTunes and Google Play app
stores:
• List of current medications
• Prescription ID card
• Refill and renew prescriptions
• Order status of prescriptions
• Locate an Express Scripts
pharmacy
William Shakespeare
04/23/1616
• Call Express Scripts at
1-800-718-6590
•Representatives are available 24
hours a day, 7 days a week
For Anthem members: How to fill a prescription using Express Scripts
12
Resources – www.mypgebenefits.com
• Details on the Anthem HAP
for 2014
• Accessed from any
computer with internet
access
• What to expect at the doctor
and pharmacy on your first
visits in 2014
• How to use your different
cards
• Where to get more
information as you use the
plans
*Review the HAP User Guides, under the Resources
tab, for information about your health account plan
For Anthem members: How to fill a prescription using Express Scripts
13
Resources – Provant
Want to talk to an expert about the Health Account Plan (HAP)?
• Contact Provant–your one-stop shop for health and wellness
• Match you to the right wellness tools and resources for your
specific health goals
• Help you understand how the HAP works
• Resolve claims or billing questions
• Email Provant at [email protected]
• Call 1-866-271-8144 Monday–Friday from 5 a.m.–5 p.m. PT
• Visit https://pge.provantonline.com
For Anthem members: How to fill a prescription using Express Scripts
14
Questions?
READ AND DELETE
For best results with this template,
use PowerPoint 2003
For Anthem members: How to fill a prescription using Express Scripts