Express Scripts Contact Information

  • Website
  • Mobile App
  • Express Scripts Medicare Member Services: 1-877-680-4883
  • State of Delaware Office of Pensions: 1-800-722-7300
  • Statewide Benefits Office: 1-800-489-8933

Benefit Descriptions

  • State of Delaware Medicare Prescription Plan: Express Scripts Medicare (PDP) Prescription Drug Plan
  • State of Delaware Medicare Supplement Plan (provided by Highmark Delaware): Group Special Medicfill Health Care Plan
  • Eligibility Criteria For Enrollment In Both Prescription and the Special Medicfill Medicare Supplement Plan
    • If eligible, you may enroll in Special Medicfill and Express Scripts Medicare (PDP) Prescription Drug Plan when:
      • You are retired and turn 65 (enrollment in Medicare is required).
      • You are 65 or older when you retire (enrollment in Medicare is required and must be effective on your retirement date).
  • Covering a Spouse
    • Complete a new Spousal Coordination of Benefits Form if your spouse is enrolled in the Highmark Delaware Special Medicfill Supplemental Plan and your spouse's employment status or health insurance has changed since the last time you completed a Spousal Coordination of Benefits Form.
  • Important Notes
    • Coverage through another Medicare Part D prescription drug plan is not allowed if you wish to keep your prescription coverage through Express Scripts Medicare (PDP). If you enroll in another Medicare prescription drug plan, prescription drug coverage through the State of Delaware for you will terminate.

      Retirees and/or their dependents must enroll in Medicare A and B when eligible due to age or disability, and a signed copy of the Medicare card must be submitted to the Office of Pensions or to the non-State participating group's benefits office prior to enrollment in the Highmark Delaware Special Medicfill with prescription coverage.

      When your enrollment is submitted for Express Scripts Medicare prescription coverage, you will first receive a pre-notification letter from Express Scripts, and you will receive new identification cards in the Welcome Kit a few weeks later.

2017 Formulary Information

  • Medicare Part D 2017 List of Covered Drugs
  • State of Delaware 2017 Additional Coverage (This drug listing is subject to change throughout the plan year. For a complete listing please visit the Express Scripts website or contact Express Scripts Medicare Member Services at 1-877-680-4883.)
  • 2017 State of Delaware Medicare PDP Level Exclusions
    • Erectile Dysfunction Medications
      • Effective January 1, 2016, medications used to treat Erectile Dysfunction (ED) are not covered, unless medically necessary for a condition other than ED. Coverage of erectile dysfunction medications for medical necessity requires coverage review for a prior authorization (PA). You or your doctor may contact the Express Scripts Medicare PDP dedicated coverage review information line at 1-800-413-1328 for further coverage review assistance. Erectile Dysfunction medications can be obtained at the pharmacy with a prescription, paying 100% of Express Scripts discounted price.

Rates effective January 1, 2016

Prescription Coverage 30-Day Supply 90-Day Supply
Tier 1
$8.00 $16.00
Tier 2
Preferred (Formulary)
$28.00 $56.00
Tier 3
Non-Preferred (Non-Formulary)
$50.00 $100.00

Cost Savings With 90-Day Prescriptions: You'll pay only 2 times your 30-day retail co-payment if you order up to a 90-day supply of covered medication at a 90-day participating pharmacy or through Express Scripts mail order service.

Retail Pharmacy

You may have your prescriptions filled at any pharmacy that participates in the Express Scripts network. If the pharmacy is also a 90-day participating pharmacy, you may fill maintenance or other prescriptions for up to a 90-day supply. If the pharmacy is not a 90-day participating pharmacy, you can fill prescriptions for up to a 60 day supply.

To verify coverage at a particular pharmacy, check the Express Scripts Website or call Express Scripts Medicare Member Services at 1-877-680-4883.

Home Delivery Via Express Scripts Pharmacy

To have a new prescription filled through the Express Scripts Pharmacy:

  • You may mail the prescription, a completed mail-order form, and payment to Express Scripts Pharmacy, OR ask your doctor to fax the prescription to Express Scripts Pharmacy by calling 1-888-327-9791 for instructions.
    (Only your doctor can fax prescriptions.)
  • Refills may be ordered online at Express Scripts.

For more information, call Express Scripts Medicare Member Services at 1-877-680-4883.

Forms and Documentation

Appeal Process