Prescription Drug Insurance
Prescription Drug Information
This year, UNM is contracting directly with a Prescription Benefits
Manager (PBM), Express Scripts. This change means that there will no
longer be different prescription drug formularies for those enrolled in
Lovelace or Presbyterian. All employees enrolled in medical coverage
will access the same prescription drug formulary. Prescription drug
benefits have been enhanced including a reduced co-pay ($10) for 90-day
supplies of generic mail-order prescriptions and a $0 co-pay for certain
diabetes drugs (see below for more details). UNM has worked with Express
Scripts, Lovelace, and Presbyterian to ensure that current prescription
refills and prior authorizations have been transferred (see Employees with Open Refills
below for more information).
Return to Top
Employees with Open Refills
Open refills are prescriptions that are eligible for additional
refills after June 30, 2009. Lovelace and Presbyterian have transferred
open refills to Express Scripts, and those refills are now available for
ordering. To receive additional refills for transferred prescriptions,
members will still need to contact the Express Scripts Member
Services , or log on to the Express Scripts website.
Express Scripts needs to know when deliveries should start, the
preferred medication type, and payment information before refills can be
sent.
Return to Top
New
Prescriptions
For new prescriptions, members can mail in their prescriptions using
an Express Scripts form (which will be available online soon). Members
should have received this form with their ID cards. If members call Express Scripts ,
representatives can provide assistance over the phone. Members are also
instructed to register at the Express Scripts website to
manage prescription requests. In addition to mail service, prescriptions
can be filled at most local retail pharmacies. Express Scripts is
contracted with over 50,000 pharmacies nationally including Walgreens,
Wal-Mart, and other contracted pharmacies. The process is almost
identical to UNM's previous carriers.
Return to Top
Covered
Medications (Formulary)
A basic summary of covered medications, not including the co-pay tier
level, is available here. For more specific information, members can
contact Express Scripts
Member Services to obtain specific co-pay information for covered
medications. Additionally, the Express Scripts website allows
members to enter a specific drug and related regimen information, and
the cost information will be displayed for each drug entered, including
mail order prices.
Return to Top
Diabetic
Services/Supplies
Certain diabetic supplies, as defined by procedure and/or diagnosis
code, will be available at a $0 co-pay. Employees should contact Express Scripts Member
Services for specific pricing as some of the items listed may be
limited to a specific product line, and/or the procedure/diagnostic code
provided by your physician may result in some items being excluded from
coverage. Other non-preferred product lines may be covered at a higher
co-pay, so it is very important for employees to contact Express Scripts
for specific coverage and pricing information. Click here for a summary
of supplies/equipment.
Return to Top
Prescription Drug ID Cards
You will receive Prescription Drug ID cards from Express Scripts. If
you did not receive your ID card, please contact Express Scripts to have
one sent to you. In the meantime, you may use the Temporary
Proof of Benefits letter to obtain prescriptions. You must
remember to provide your Express Scripts ID card to your pharmacist
beginning July 1, 2009.
Return to Top
Frequently
Asked Questions
- Why
is UNM changing to Express Scripts?
- Where
do I fill my prescriptions after 7/1/2009?
- Where
is the Express Scripts mail pharmacy located?
- When
do we become active with Express Scripts?
- Do
I need to ask my doctor for a new prescription to use the Express
Scripts mail order service?
- Will
my mail order refills be transferred to Express Scripts?
- Will
my outstanding balance or credit be transferred also?
- Will
my credit card information transfer to Express Scripts?
- Will
my prior authorization information transfer to Express Scripts?
- I
just filled a prescription through mail order and it has 3 refills.
Will I need a new prescription?
- I
mailed my new prescriptions before I found out about the change to
Express Scripts. What should I do?
- I
sent my payment to my current provider. Will Express Scripts still send
my medication?
- When
can I send my new prescription order to Express Scripts?
- How
do I order my prescription with Express Scripts?
- How
can I get a mail order form for Express Scripts?
- How
do I pay for my mail order with Express Scripts?
- How
long will it take to receive my order from Express Scripts?
- If
my medication is not covered, will Express Scripts notify me?
- Can
I still get a 90 day supply through Express Scripts mail pharmacy?
- Will
I get a new member ID card?
- How
can I get a member ID card?
- Can
I fill my local prescriptions with a pharmacy that is not in the
Express Scripts pharmacy network?
- How
does my local pharmacy join the Express Scripts pharmacy network?
- My
local pharmacy is having trouble filling my medication. Can you help?
- How
do I obtain a Prior Authorization for a medication?
- Can
my local pharmacist request a Prior Authorization on my behalf?
- Does
Express Scripts have a website?
- How
do I register for the website?
- Does
each family member need their own user ID and password for the website?
- Do
I pay for shipping if my medication requires overnight method?
- I
cannot open child proof caps on medication bottles. Can I get a regular
cap?
- I
am getting divorced (or I am divorced). I am still covered under my
spouse's plan. I don't want to put my credit card number on my spouse's
account. How do I pay for my medication?
- What
is the number to Express Scripts Customer Service and their hours of
operation?
Return to Top
Express Scripts Member
Services and Contact Information
For additional information or questions, a UNM-dedicated member
services number is available. The member services line is able to
provide drug coverage and pricing information and answer questions on
mail ordering and other prescription coverage information. Contact
Express Scripts Members Services at:
(800) 232-6549
(800) 899-2114 (TDD)
www.express-scripts.com
Return to Top
