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Mandatory Mail Order Maintenance Drug Program
Maintenance medications (those taken regularly over an extended period) cannot be filled in monthly quantities after they have been filled three (3) times (original prescription plus two (2) refills), regardless of the number of refills indicated on the prescription. After the second refill, to continue using the drug, you must obtain a new prescription from your physician for 90 days supply and then use the ESI Home Delivery Service.
Examples of maintenance drugs are drugs prescribed for high blood pressure, high cholesterol, anxiety, arthritis, asthma, and depression.
How is this requirement going to save me money?
The ESI Home Delivery Service program is designed, through bulk buying discounts and rebates, to provide substantial savings to the Fund and the convenience of receiving prescription drugs at home for a lower copayment to the member. Look at the following example:
If you take one pill per day of a preferred brand-name formulary drug (Tier 2), you can get a one-month supply for $15. Filled three times, for 90-days worth of drugs, your cost is $45.
By utilizing the ESI Home Delivery Service, your cost for the same medication for the same 90 days is $30.
Not only is either option more convenient, it also saves you money in every instance.
How does the ESI Home Delivery Service work?
It is very simple. Just mail original prescriptions in the postage paid envelope along with a completed Order Form to the ESI Home Delivery Service. Both are available from your Chapter Leader, the Welfare Fund, or ESI.
Must I use the ESI Home Delivery Service Order Form to send in prescriptions?
The Order Form is provided only as a convenience; however, it will expedite your order. If you choose not to use the form (which is also available on the www.express-scripts.com website), you must indicate your ID number and group number copied from the UFT Welfare Fund/ESI Prescription Drug Identification (ID) Card.
Must I use the ESI Home Delivery Service postage-paid envelope to send in prescriptions?
The envelope is provided only as a convenience. Whether you use it or your own, what must be clear to ESI is the address where you would like the drugs to be sent. If you do not indicate an address, your prescriptions will be sent to the address listed on the Welfare Fund’s database.
How much time should I allow for my prescriptions to be delivered and what will be included with my order?
Prescriptions are filled within 48 hours; however, you must allow delivery time both ways. Your medication will be delivered to your home or to any location you request within 10-14 business days of your initial request by first class mail or United Parcel Service (UPS).
Accompanying your medication will be:
- an ESI Home Delivery Service Order form and envelope to order your refill(s) and/or future prescription(s); and
- a “Product Information” sheet, which has useful information regarding your medication(s); and
- an invoice that can be used as a paid receipt; and
- a Doctor Fax Form if you have no refills left and 45 your physician would like to continue to prescribe the same medication.
Is there a limit to the number of prescriptions I can send in?
No. There is no limit to the number of prescriptions that can be included in one envelope.
What do I have to pay for my medications?
You will be required to make an out-of-pocket payment (copayment) toward the cost of the drug until you reach the annual $1,000.00 maximum out-of-pocket expense limit. The copayments are:
- $10.00 for Generic drugs (Tier 1)
- $30.00 for Preferred Brand drugs (Tier 2)
- $70.00 for Non-Preferred Brand drugs (Tier 3)
After you reach $1,000.00 in copayments, no further copayments will be collected, except for those drugs obtained in Tier 3 where you are responsible for the appropriate copayment of $70.00.
Please note: If you were in the Cost Care program, you would also be responsible for the ancillary charges.
You must always pay the copayment or the calculated fee schedule, whichever is less. For example, if the calculated fee schedule price of your Preferred Brand prescription is $23.00, then you will pay $23.00 instead of $30.00 (the usual copayment).
I have prescriptions on file at my local pharmacy. Can they be transferred?
No. Prescriptions on file at a local retail pharmacy cannot be transferred. In addition, telephone prescriptions and photocopies cannot be accepted.
What quantities are permitted through the ESI Home Delivery Service?
ESI Home Delivery Service is authorized to dispense up to a 90-day supply, or three (3) prepackaged items, whichever is greater, with up to three (3) refills, regardless of the number of refills indicated on the prescription by the physician, if indicated on the prescription, within one (1) year from the date the prescription is written. If further medication is necessary, a new prescription must be obtained from the patient’s prescriber.
Can I use ESI Home Delivery Service for drugs in all three tiers?
Yes, if they are maintenance drugs. ESI Home Delivery Service program fills prescriptions for maintenance drugs for members for any generic or brand name drugs — Tiers1, 2 or 3 — through the mail. The telephone number is 800-723-9182 and the website is www.express-scripts.com.
When should I not use ESI Home Delivery Service?
Drugs used for short periods and/or drugs that must be started immediately. These are called acute drugs. Examples include antibiotics and drugs used in emergencies.
Note: Controlled substances or other medications, when mandated by law or the FDA, which your physicians must order monthly, should be ordered from your local pharmacy and not from the ESI Home Delivery Service.
I only use brand name drugs. Can I get them through this service?
Yes. However, members who belong to the Cost Care Program must pay the difference between the cost of the name-brand drug and the generic (known as the ancillary charge), if one is available, in addition to the applicable copayment.
I have many prescriptions. How do I know how much to make my check out for?
The formulary list can be used as a guide to determine how much your copayment will be for your ESI Mail order.
- Medications that are listed in lower case letters are generic medications and have the lowest copayment (Tier 1).
- Medications that are listed in capital letters are preferred brand medications and have the middle copayment (Tier 2).
If your medication does not appear on the formulary, or you have any questions or concerns, call ESI’s Customer Service at 800-723-9182. A representative will verify your copayment. You can also check your copayments online at www.express-scripts.com.
Since I am in the Cost Care program, how will I be charged for a brand name drug ordered through the mail when a generic is available?
You will receive a bill for the difference between the brand name and its generic equivalent when you receive your prescription(s). It is important that this bill be paid to ESI within ten (10) days of receipt.
Does ESI Home Delivery Service accept credit cards?
Yes. In fact, if you wish, the company will keep your credit card information on file to make payment easier.
Suppose I have questions about an interaction with other medication(s) that I am taking, or possible reactions to the medication itself?
Your doctor should alert you to possible reactions and should know other medications you are taking for possible interactions. However, if you ever have a question of that nature, ESI always has a pharmacist on duty 24 hours, 7 days a week. You may also visit www.express-scripts.com for information about interactions and side effects.
How do I get an Order Form and/or postage-paid envelope?
You will receive one every time you receive an order from the ESI Home Delivery Service. The forms and envelopes are also available:
- from your chapter leader; or
- by calling the Welfare Fund during business hours at 212-539-0500 or
- by calling the ESI hotline at 800-723-9182 — open 24 hours a day, seven days a week.
Can I have my drugs shipped anywhere?
Anywhere in the U.S., but due to different rules and regulations in other countries, medications cannot be shipped abroad. You can have the medication shipped to your place of business, your spouse’s/domestic partner’s place of business, your dependent’s college dorm, etc., as long as it is in the United States.
Just be sure to clearly indicate the address where you want the medications to go when you send in your prescriptions or refill form. If you do not indicate an address, your prescriptions will be sent to the address listed on the Welfare Fund’s database.
I was just prescribed a new medication that my physician wants me to start right away and I will be using it for a length of time. How can I best utilize the program?
Ask your physician for two prescriptions. The first should be written for a 30-day supply and should be taken to your local pharmacy, where you will use your drug ID card. The second prescription should be written for a 90- day supply. You should immediately mail it to the ESI Home Delivery Service.
How can I be sure that I will not run out of a medication before my refill arrives?
While you receive a three-month supply of medication, refills may be ordered after two months. Therefore, if at the start of the third month you reorder your medication(s), you will be sure not to run out.
How do I order refills?
This can be done three different ways:
- The fastest way is by using the ESI website (www.express-scripts.com); or
- The next fastest way is to use the automated touchtone refill system by calling 800-723-9182 and follow the instructions; or
- You may also put the refill slip that came attached to your statement along with a check (or fill in the credit card information) into the postage-paid envelope — or any stamped envelope — and mail it.