Office of Management and Budget : Statewide Benefits Office >> Benefit Programs

EXPRESS SCRIPTS MEDICARE RETIREE PRESCRIPTION PLAN


Express Scripts Medicare (PDP) for the State of Delaware is the State's Medicare Prescription Plan for retirees enrolled in Highmark Delaware Special Medicfill (the State of Delaware Medicare supplement plan).

  • If eligible, you may enroll in Special Medicfill and Express Scripts Medicare during the Open Enrollment period in October, or when:
    1. You are retired and turn 65 (enrollment in Medicare is required).
    2. You are 65 or older when you retire (enrollment in Medicare is required and must be effective on your retirement date).

     
  • Do you cover a spouse? You must complete a new Spousal Coordination of Benefits Form when your spouse's employment status or coverage has changed since you last completed this 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. 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 Plan with or without Prescription Coverage Plan.
    • When your enrollment is first 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.
  • Special Medicfill Rates Beginning January 1, 2015:
 

Plan

Special Medicfill with Prescription

Special Medicfill without Prescription

2015 Monthly Rate

$362.98

$205.80


  • Contacts

    • Express Scripts Contact Information

      • Website
      • Mobile App
      • Express Scripts Medicare Member Services: 1-877-680-4883
        (Available 24 hours a day, 7 days a week, 365 days a year Pharmacists available around the clock)

  • State of Delaware Office of Pensions: 1-800-722-7300

Prescription Copays


  Rates effective through June 30, 2015
 
STATE OF DELAWARE
PRESCRIPTION COVERAGE
TIER 1
GENERIC
TIER 2
PREFERRED
(FORMULARY)
TIER 3
NON-PREFERRED
(NON-FORMULARY)
30-DAY SUPPLY $8.50 $20.00 $45.00
90-DAY SUPPLY $17.00 $40.00 $90.00

    • 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.


    • Programs

  • Coordination of Benefits/Direct Claims for Prescriptions

    • DIRECT CLAIM FORM FOR EXPRESS SCRIPTS MEDICARE - You may print copies of this form for use when a pharmacy requires that you pay out of pocket for a prescription for one of the following reasons:
      • The pharmacy is a non-participating pharmacy.
      • You have other coverage that is primary, and this is a coordination of benefits claim.
       
    • Please be sure to read the form carefully, check the appropriate reason for using a non-participating pharmacy, complete all requested information and include all receipts. Please be sure to keep a copy for your records.

    • How Direct Claims and Secondary Prescription Claims Pay
  • Pharmacies

    • Retail Pharmacies - You may have your prescriptions filled at any pharmacy that participates in the Express Scripts Medicare 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 1-877-680-4883.

    • Express Scripts Pharmacy (mail order prescription service)
      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 Member Services at 1-800-939-2142 (if you are not enrolled in Medicare) or 1-877-680-4883 (if you are enrolled in Medicare).

  • Worry-Free Fills Program: If you fill your prescriptions through the State of Delaware prescription plan using mail order, an automatic refill service called Worry-fee Fills is now available to you. See how this works.

  • Specialty Pharmacy (Accredo and Biotek Remedys) - Some health conditions require medications that are classified as "specialty medications" and are provided through Accredo and Biotek Remedys Specialty Pharmacy. For example, medications used to treat some forms of cancer, Multiple Sclerosis, hepatitis C, and rheumatoid arthritis are classified and administered as specialty medications. Members may receive their first 30-day fill of a new specialty medication through a retail pharmacy, but must have subsequent refills of the same medication provided by Accredo or Biotek Remedys. Staff from Accredo or Biotek Remedys will reach out to physicians and members to work together in managing the member's prescription needs.

    When a member receives medication through Accredo or Biotek Remedys, a patient care coordinator is assigned to that member. The member is welcome to contact the assigned patient care coordinator to discuss his/her prescription needs and health condition. Prescriptions are delivered directly to a member's home with unique packaging, as necessary, to ensure safety.

    Accredo's dedicated customer service number is 1-800-803-2523.

    Biotek Remedys is located in New Castle, DE and their customer service number is 1-877-246-9104.


Last Updated: Monday, 30-Mar-2015 13:43:46 EDT
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