Express Scripts Q&As

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Updated February 3, 2021

Q1. I used mail order with OptumRx; will l have to get a new prescription?

In most cases, if you had remaining refills with OptumRx home delivery, you will not need to get a new prescription. The refills were automatically transferred to Express Scripts Pharmacy home delivery service. You won't need to get a new prescription from your doctor. However, you must take action to start home delivery through Express Scripts for transferred prescriptions — even if you had automatic refills set up with OptumRx.

To refill transferred prescriptions online, register and log on to the Express Scripts website (one-time registration is required) and click on Available Refills. Add the desired medication(s) to your cart and proceed to checkout where you will need to provide your address and payment information.

During checkout, you also have the option to start automatic refills for your medication. If you used automatic refills with OptumRx, your shipping and payment information was not transferred to Express Scripts. Once you get your first refill through Express Scripts Pharmacy, you can set up automatic refills going forward, if you wish.

Note: Prescriptions for controlled substances and expired prescriptions were not transferred to Express Scripts. If you need a refill for a prescription that was not transferred from OptumRx, ask your doctor to e-prescribe or fax a new prescription for up to a 90-day supply to Express Scripts. Or call Express Scripts at 800-344-3896 and they will contact your doctor for a renewal on your behalf. Retired members should call 877-856-4694.

Q2. What are automatic refills?

With automatic refills, you don't need to order a refill to get your medicine. Express Scripts will process your next refill before your medicine is supposed to run out. You won't be billed until your medication is shipped. Express Scripts will also contact your prescriber when it's time to renew your prescription.

Express Scripts will send you a reminder before processing each automatic refill, giving you time to change the processing date, shipping address, or to cancel the refill if it is no longer needed.

You have the option to set up automatic refills when refilling your prescription(s). However, some medications do not qualify for automatic refills. Express Scripts can't send automatic refills for controlled substances, specialty medications, or drugs used on a short-term basis (like allergy or pain medicines).

Q3. My medication bottle shows remaining refills, but I don't see my medication under Available Refills on express-scripts.com. Why not?

The following prescriptions were not transferred from OptumRx to Express Scripts so you will not see them listed under Available Refills:

  • controlled substances
  • long-term medications with no remaining refills
  • expired prescriptions even if there were remaining refills (Depending on the drug, prescriptions expire after six months to one year from the date the prescription was written.)

If the prescription was filled in 2020, it will be listed as part of your claims history on the Express Scripts website. To view, log on to express-scripts.com (or use the single sign-on feature through Benefits Connect), click on Prescriptions, and select Claims & Balances from the drop-down menu. Then click on Prescription Claims & History and select Last 12 months. In addition to prescriptions filled through mail order in 2020, you will also see medications you obtained at retail pharmacies last year.

If you need a refill for a prescription that was not transferred from OptumRx, ask your doctor to e-prescribe or fax a new prescription for up to a 90-day supply to Express Scripts. Or call Express Scripts at 800-344-3896 and they will contact your doctor for a renewal on your behalf. Retired members should call 877-856-4694.

Q4. How can I find out if I have remaining refills that transferred to Express Scripts?

Log on to express-scripts.com (or use the single sign-on feature through Benefits Connect) and click on My prescriptions. Current prescriptions with remaining refills that transferred from OptumRx will be listed on the page, along with the number of refills remaining for each. When you need more of your medication, you can begin filling these prescriptions through Express Scripts home delivery.

To refill transferred prescriptions, register and log on to the Express Scripts website (one-time registration is required) and click on Available Refills. Add the desired medication(s) to your cart and proceed to checkout where you will need to provide your address and payment information. You also can set up automatic refills going forward if you wish.

Instructions for using Express Scripts home delivery are included in the welcome package mailed with your ID cards.

Note: Prescriptions for controlled substances and expired prescriptions were not transferred to Express Scripts.

Q5. What if I need to refill a prescription that wasn't transferred to Express Scripts?

If you need a refill for a prescription that was not transferred from OptumRx to Express Scripts, ask your doctor to e-prescribe or fax a new prescription for up to a 90-day supply to Express Scripts. Or call Express Scripts at 800-344-3896 and they will contact your doctor for a renewal on your behalf. Retired members should call 877-856-4694.

Q6. Will my prior authorization transition to Express Scripts?

Unless they have recently expired, your prior authorization (PA) records were transferred from OptumRx to Express Scripts. If the PA was no longer valid, your doctor can submit a request for a new PA to Express Scripts.

Q7. I currently use a specialty medication that I get through the mail. How do I continue to fill my specialty prescription?

If you had remaining refills, OptumRx Specialty Pharmacy will transfer those refills to Accredo, an Express Scripts specialty pharmacy.

If you did not have remaining refills with OptumRx Specialty Pharmacy, ask your doctor for a new prescription. Provide your doctor with your Express Scripts member ID number (shown on the Express Scripts ID card mailed to you in December). Your doctor can either call or fax your prescription to Accredo and an Accredo patient-care representative will work with your doctor to help make the transition smooth for you and will call you to arrange for delivery of your medications on a day that is convenient for you.

Q8. How can I calculate my out-of-pocket cost for a covered drug?

Log on to express-scripts.com (or use the single sign-on feature through Benefits Connect) and click on Price a Medication in the menu under Prescriptions to calculate the estimated cost of a prescription drug.

Note: The Price a Medication calculator does not imply a guarantee of coverage as covered products or categories are subject to individual plan restrictions and/or limitations. 

Q9. Will my out-of-pocket cost for my medication stay the same?

The plan's cost-sharing provisions in the form of copay and deductible amounts, coinsurance rates, and minimum and maximum amounts have not changed. For example, the same copays apply for preventive drugs as in 2020. You pay a percentage (a coinsurance) of the drug cost up to a maximum amount for other covered drugs. There's also a minimum amount that applies. These percentage (coinsurance) rates and minimum and maximum amounts also have not changed. However, for drugs that require you to pay a percentage of the cost, your out-of-pocket cost may be different if the price of a drug increases or decreases. If a drug's price increases, you won't pay more than the plan's maximum amount.

Your out-of-pocket cost may also be different if you changed medical options, or if the drug is no longer on the plan's formulary.

The best way to calculate your 2021 costs for covered drugs is to log on to express-scripts.com (or use the single sign-on feature through Benefits Connect) and use the Price a Medication tool.  

Note: The Price a Medication calculator does not imply a guarantee of coverage as covered products or categories are subject to individual plan restrictions and/or limitations. 

Q10. Am I going to have to change my medication?

Effective January 1, 2021, the plan's list of preferred drugs — the formulary — changed. As a result, some drugs that were on the 2020 formulary became non-formulary drugs, and vice versa. The plan's drug exclusion list also changed effective January 1, 2021. The formulary and drug exclusion lists change every year whether or not the Board changes its pharmacy benefits manager.

Express Scripts mailed letters in November and December to members affected by changes to the formulary or drug exclusion list for them to discuss alternatives with their doctor.  

Of course, you can always continue to use your current medication, but your cost will increase. To calculate the estimated cost of a prescription drug, log on to express-scripts.com (or use the single sign-on feature through Benefits Connect) and click on Price a Medication in the menu under Prescriptions.

Note: The Price a Medication calculator does not imply a guarantee of coverage as covered products or categories are subject to individual plan restrictions and/or limitations. 

Q11. Is there a new preventive drug list?

The 2021 preventive drug list includes essentially the same medications as the 2020 preventive list; however, not all strengths or dosages of some medications are on the 2021 list.

You can also log on to express-scripts.com (or use the single sign-on feature through Benefits Connect) to look up coverage information and costs for your medication.

Q12. Will new ID cards be issued?

Yes, all members enrolled for 2021 medical coverage will receive new prescription ID cards in a welcome package from Express Scripts. You should begin using your new prescription ID card when filling prescriptions at participating retail pharmacies. (You should destroy your old cards.)

Two ID cards will be included in your welcome package from Express Scripts. Some members may receive a duplicate set of ID cards from Express Scripts. If you receive a second set, you may keep the duplicates to use or simply destroy them. You can also order additional cards by calling Express Scripts dedicated customer service line or you can log in to express-scripts.com to download an ID card.

Note: The prescription ID card will cover all enrolled family members. Separate prescription ID cards will not be issued for family members.

Q13. What if I don't receive my new ID cards?

If you haven't received your new Express Scripts prescription ID cards you can download an ID card from express-scripts.com. Log on (or use the single sign-on feature through Benefits Connect) and click on Account then Member ID Card to download a card. You can also use the Express Scripts mobile app to access a virtual ID card you can show at the pharmacy. Or, call Express Scripts at 800-344-3896 to request a new card. If you're enrolled in Medicare Supplement and haven't received your new cards, call 877-856-4694.

Note:Some members may receive a duplicate set of ID cards from Express Scripts. If you receive a second set, you may keep the duplicates to use or simply destroy them. 

Q14. What is the toll-free number for Express Scripts customer service and when is it available?

Express Scripts customer service is available 24 hours a day, seven days a week and can be reached at 800-344-3896.

If you are enrolled in the Medicare Supplement Plan, a separate dedicated line is available at 877-856-4694.

Q15. Can I still use the same pharmacy?

Like OptumRx, Express Scripts has contracted with a large network of pharmacies, including national chains and many smaller retail pharmacies, so it's likely your pharmacy is a participating Express Scripts pharmacy. You can find participating pharmacies by logging on to express-scripts.com or calling Express Scripts at 800-344-3896. Retired members should call 877-856-4694.

If your pharmacy is not a participating Express Scripts pharmacy and would like to join the network, they should contact the Express Scripts Pharmacy Helpline at 877-728-0177 or email their contracting department at networkcompliance@express-scripts.com.