Mandatory maintenance drug program
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 a 90-day supply. Then, you must use either of the following options:
- ESI Home Delivery Service, or
- The Smart 90 Walgreens/Duane Reade Retail Network
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?
If you take one pill per day of a preferred brandname formulary drug (Tier 2), you can get a one-month supply for the $15 co-payment. Fill that script three times, for a total of a 90 day supply of drugs, your cost is $45.
By utilizing the ESI Home Delivery Service or the Smart 90 Walgreens/Duane Reade Retail Network, your cost for the same medication for the same 90 days is $30.
Both methods offer convenience and save you money on your long-term medications as the copayment structure remains the same for either option.
How does the ESI Home Delivery Service work?
Have your provider electronically e-prescribe your prescription for a 90-day supply, where legally permissible, to ESI Home Delivery Service. Your provider should include your 10 digit UFT Welfare Fund ID number when they transmit your prescription to ESI Home Delivery Service.
How much time should I allow for my prescriptions to be delivered and what will be included with my order?
Prescriptions are processed and shipped within 72 hours. Your medication will be delivered to your home or to any location you request within 10 to 14 business days.
Accompanying your medication will be:
- An ESI Mail 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 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. Your provider must e-prescribe a new prescription to ESI.
What quantities are permitted through the ESI Home Delivery Service?
ESI Home Delivery Service is authorized to dispense up to a 90-day supply, with up to three (3) refills, 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 — Tiers 1, 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.
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 Home Delivery or Smart 90 program?
Ask your physician for two prescriptions. The first should be e-prescribed to your local pharmacy for a 30-day supply, where you will use your UFT Welfare Fund/Express Scripts Prescription ID card. The second prescription should be written for a 90- day supply and electronically sent to ESI Home Delivery Service or at the Walgreens/Duane Reade you wish to pick up your prescription through the Smart 90 Walgreens/Duane Reade Retail Network.
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.
Is the ESI Home Delivery Service unionized?
Yes. At ESI Home Delivery Service located in Florence, New Jersey, the pharmacists and other employees are members of the United Steel Workers union.