Express Scripts Pharmacy Coverage

▼   How do I maximize my prescription drug coverage benefits?

The following will help to maximize your prescription drug coverage benefits:

  • Use generic drugs whenever possible.
  • If you are taking a brand-name drug that is not on your formulary, ask your doctor if a formulary drug or a generic would be right for you.
  • Use your Home Delivery program for maintenance medications. Maintenance medications are prescription drugs that you take regularly to treat ongoing conditions like diabetes, high blood pressure and asthma. You can usually save time and money by using the Express Scripts Pharmacy to fill your maintenance medications.
  • Use participating local pharmacies to fill your short-term prescriptions. For example, your doctor might prescribe a 15-day medication for an infection. You should always get these types of medications from a participating local pharmacy.
▼   How can I calculate my out-of-pocket cost for a preferred or a non-preferred drug?
There is a tool on called "Price a Medication" that will help you calculate the estimated cost of a prescription drug. Register on, and click on "Price a Medication".

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. The Price a Medication tool displays cost and coverage information for the current calendar year.
▼   Are generics safe?
Yes. Generic drugs, like brand-name drugs, must meet established FDA standards of quality and purity to help ensure their safety and effectiveness, and they usually cost less. Generic versions have the same active ingredients as their brand-name counterparts, and they are equal in strength and dosage. Sometimes drug manufacturers use different inactive ingredients, such as fillers and dyes, which affect a drug’s shape, color, size or taste.
▼   Why should I consider generics or preferred brand-name drugs?
You may save money by taking generics or preferred brand-name drugs because they usually cost less under your plan than non-preferred brand-name drugs. Many new generics have become available over the past year. If you are taking a non-preferred drug, ask your doctor whether a lower-cost option would be right for you.
▼   How do I know whether my medication is covered or whether there is a generic equivalent?
To find coverage and pricing details online, and to find out if your medication has a generic equivalent, visit register and log in, and choose “Price a Medication” from the left-hand menu or contact customer service at 855-687-3857.
▼   Will there be changes to my plan’s list of preferred drugs?

Yes, effective January 1, your plan’s formulary (a list of preferred medications) will change. As a result, some preferred medications will become non-preferred, and vice versa. You may register on to find out which medications are preferred. If you are taking a brand-name drug that is about to become non-preferred, you may want to talk to your doctor about a lower-cost option.

  • Preferred (or formulary) medications are on the formulary and cost less than
    non-preferred medications. This list of drugs is determined based on the
    advice of pharmacists and a group of independent doctors.
  • Non-preferred (or non-formulary) medications are not on your list of
    recommended drugs and may cost you more.