Prescriptions Express Scripts

Express Scripts Claim Form

Express Scripts FAQ’s

Diabetes Patient Assurance Plan

Through the Patient Assurance Program, eligible members will never pay more than $25 per 30-day supply of preferred formulary insulin products. It’s already included in your benefit – so there’s no additional fee! *Mail order participants will continue to pay the standard, lower copay.

Diabetes Care Value Program

The Diabetes Care Value Program combines a quality-based pharmacy network and a holistic approach to diabetes patient care. The program applies to all A&M Care health plan members who purchase oral and injectable diabetes drugs as well as the diabetes blood glucose test strips.  For the prescription to be covered under the A&M Care health plan, the program requires that:

• diabetes-related prescriptions be filled with a 90-day supply rather than a 30-day supply, and
• diabetes-related prescriptions be filled through Express Scripts Home Delivery (mail-order) or a Walgreens pharmacy (retail).

Diabetes Care Value Program FAQ’s

Inside RX Pets

A prescription savings program to provide pet parents discounts on brand and generic human medications prescribed for pets at 40,000 participating retail pharmacies. The program applies to all A&M Care health plan members (including 65 Plus Medicare PPO) with Express Scripts prescription drug coverage.

Inside Rx Pets provides you with:

• 77% average savings on the cost of generic medications
• 15% average savings on the cost of brand medications
• Easy access to savings at one of 40,000 participating retail pharmacies.

How to use Inside RX Pets:

1. Go to Insiderx.com/pets to download your Inside Rx Pets card.
2. Once you have your card, use the online calculator to see how much you can save on your pet’s prescription medications or take your card to a participating pharmacy along with your pet’s prescription from the veterinarian.
3. Enjoy the savings at a participating pharmacy when paying for your pet’s medication.

Inside RX Pets FAQ

Prescription Care Management (PCM)

In addition to our prescription benefit plan – the Prescription Savings Program by PCM is a program that works with employees, their doctors and pharmacies to save the member money on prescription drugs. PCM offers members a choice to switch from higher cost drugs to a lower cost, equally-effective therapeutic alternative. As a plan participant, no action is required unless PCM contacts you. PCM will contact your physician first to ask if the alternative will work with your medical history and if the physician approves. If so, then PCM will contact you for your permission to change medications. PCM will answer all of your questions and take care of the work. This program does not change the current pharmacy benefits offered by Texas A&M University System and administered by Express Scripts. Should you receive a call from PCM, contact their member services department at 1-800-281-7050 with any questions or concerns.

SaveOn SP

SaveOn SP is an Express Scripts program that lowers the cost of a number of specialty drugs for both the members and the plan by taking advantage of manufacturer assistance programs. The specialty drugs are in specific medication categories such as Hepatitis C, Multiple Sclerosis, Oncology, Rheumatoid Arthritis, and a few others. If you participate in this program, you will have a zero cost for certain specialty medications. Your prescriptions will still be filled through Accredo, your existing specialty mail pharmacy.

• The cost of these drugs will not count towards the annual out-of-pocket maximum, and
• All plan members must use the Accredo specialty pharmacy for all specialty fills.

If you have any questions or concerns, please contact SaveonSP at 1-800-683-1074 Monday – Thursday 7:00 a.m. – 7:00 p.m. Central and Friday 7:00 a.m. – 5:00 p.m. Central

Retirees and dependents who are Medicare-Primary and enrolled in the 65+ Plan with Medicare Part D prescription drug coverage, are not eligible to participate in the SaveOn Program.  If the retiree will be Medicare-Primary at the time of the retirement date and enrolls in the 65+ Plan with the Express Scripts Medicare Part D Plan or any Medicare Advantage Plan which includes Medicare Part D, the retiree will not be eligible to continue participating or to newly enroll in the SaveOn Program.

Express Scripts Extended Payment Program

EPP allows you to spread your prescription payments over three credit or debit card installments so you don’t have to pay all at once. Go to www.express-scripts.com to enroll. More information can be found here –Express Scripts Extended Payment Program

Pulmonary Care Value Program

Express Scripts (ESI) created the Pulmonary Care Value program to improve adherence among the nearly 75% of asthma patients who fail to take their medication as directed. It includes:

• Patients must fill all pulmonary care medication 90-day prescriptions from Walgreens, home delivery, or certain
  local pharmacies. This will promote adherence and improve patient health.
• Access to one-on-one support from a team of extensively trained clinicians in ESI’s Pulmonary Therapeutic Resource CenterSM (TRC).
• High-risk patients will be offered remote monitoring devices to help optimize medication use and maximize their health. When monitoring shows that patients overuse their rescue inhalers or are not adherent to controller medications, pulmonary TRC pharmacists will reach out with individualized support.
• The Mango Health app – a patient engagement solution that gamifies health and rewards patients for making healthy decisions.

Drugs Requiring Pre-Authorization

Drug Utilization Review Process Information

Express Scripts Rural Retail Pharmacy List