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Frequent Questions

FSBP Prescription Coverage Frequent Questions

We have a list of participating pharmacies here.

For the complete drug formulary and to compare drug prices, click here. Members and prospective members can find out information on the Plan’s prescription benefits (retail, home delivery and specialty), search for a nearby participating pharmacy, compare prescription costs, review the Plan’s formulary, and more. 

To learn more about Express Scripts, the Plan’s Pharmacy Benefit Manager, click here

Express Scripts can be contacted directly by phone for any questions you may have:

  • Member Services – 800-818-6717
    • If you are located outside the 50 United States, call Express Scripts collect at 724-765-3074.
  • TTY – 800 899-2114
  • Accredo, an Express Scripts Specialty Pharmacy – 844-581-4862

There are two options you can explore: The Price a Medication tool, and the Extended Payment Plan.

Price a Medication is part of the co-branded website and app. You simply enter the medication you were prescribed and read about lower-cost alternatives for the same drug. Use this information to discuss lower-cost medications that might be appropriate for your condition with your prescriber.

The Extended Payment Plan allows you to pay for your home delivery medications over three installments, via credit or debit card.  There’s no waiting – medications are shipped as soon as the first payment is received. When you enroll in EPP, it applies to every home delivery prescription for you and your eligible dependents. To enroll or learn more, you can call Express Scripts at 800-818-6717, or enroll at the website or app. Here’s how:

  1. Under “My Account,” select “Edit Payment Information” from the drop-down menu.
  2. Under “Your Information” select “Payment Information.”
  3. Then, click on “Edit Information.”
  4. Next to “Extended Payment Program,” you will see a link to “Learn More.”

Several medications are now available with no cost-sharing for you. They are not technically “free” because the Plan pays full cost for them; thus, for members there is no out-of-pocket cost.

These medications include:

  • FDA-approved women’s contraceptives, including oral and injectable contraceptives, cervical caps, diaphragms, IUDs, vaginal rings, and hormonal patches.
  • FDA-approved tobacco cessation drugs, both prescription-only and over-the-counter (a prescription from your provider is required for reimbursement).
  • Medicines to promote better health recommended under the Affordable Care Act and that have an “A” or a “B” rating from the U.S. Preventive Services Task Force

Certain non-covered prescription drugs can be obtained at a discounted price through the Express Scripts Pharmacy. These may include Renova, a dermatological drug; Propecia, a cosmetic drug; and erectile dysfunction agents.

If you use a non-covered prescription drug and you want to learn whether it falls into this category, as well its discounted price, call Express Scripts at 800-818-6717. To order an eligible medication, you need to submit the prescription with a home delivery order form and payment for the full discounted price.

As a non-FEHB benefit, you cannot file an FEHB disputed claim about any drugs obtained via this program. Further, the price you pay for any drug in this program is separate and apart from your FSBP premium, deductible, copayments, or catastrophic protection out-of-pocket maximums

Your safety is the top concern of both Express Scripts and FSBP. We require prior authorization of certain medications as a safety measure for you to establish the medical necessity of your use of the drug. Examples of drug categories requiring prior authorization include, but are not limited to, growth hormones, certain hormone therapies, interferons, erythroid stimulants, anti-narcoleptics, sleep aids, migraine medication, weight loss medications, opioids, and oncologic agents. The review of your prior authorization request uses Plan rules based on FDA-approved prescribing and safety information, clinical guidelines, and uses that are considered reasonable, safe, and effective. Additionally, there are some medications that may be covered with limits (for example, only for a certain amount or for certain uses) unless you receive approval through a coverage review.

Contact Express Scripts Member Services directly if you have questions about, or need to obtain, prior authorization for a medication: 800-818-6717.

Your prescription drug coverage includes the Personalized Medicine Program, which incorporates pharmacogenetics testing to optimize drug therapies for certain conditions. The program is available – at no extra cost – to patients taking Plavix or Warfarin.  It requires no action on your part.

The FDA recommends pharmacogenetics tests to help doctors prescribe the most appropriate drug and dosage for each patient. First, a pharmacist from Express Scripts contacts your doctor to see if it is appropriate for you to participate in the testing. If your doctor agrees, the pharmacist will contact you to let you know that testing is available and, if you agree to it, arrange to complete the test. Results will be sent directly to your doctor and to a specially trained Express Scripts pharmacist. Ultimately, your doctor decides which drug and dose is best for you.

  1. Members receive up to a 90-day supply, free standard shipping and the option of auto refills
  2. Member outreach and engagement alerts members of potential savings opportunities
  3. Patient care advocates available around the clock to answer questions
  4. Express Scripts pharmacists available 24 hours a day, 7 days a week
  5. 99.99+% dispensing accuracy make medications safe
  6. Extended Payment Plan offered, which breaks 90-day copays into three (3) installments with no fees

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