Did you know: After the State Employee Health Benefit switched prescription providers at the start of 2014, covered employees can still opt out of mail order for prescriptions. We bring this up because members who have filled prescriptions via a local pharmacist have reported that the explanation of benefits for that prescription fill includes the following language:
You may obtain one initial fill plus two refills for maintenance or long-term medications at a retail pharmacy. It will then be necessary for you to utilize the Express Scripts Pharmacy Home Delivery Service for additional supplies. Otherwise, you will be responsible for 100% of the cost of the medication when filled at a retail pharmacy.
Workers can, however, opt out of filling prescriptions via mail order by choosing what Express Scripts calls “Select Active Choice”:
Your plan includes the Select Active Choice (Mail Order Opt Out) program. This program can be used for plan participants who feel that using home delivery service would create undue hardship. The Select Active Choice program gives you the choice of filling your maintenance or long-term prescriptions through the Express Scripts Pharmacy Home Delivery Service or at a retail pharmacy location. Please note, you may only receive up to a 31-day supply at a retail pharmacy location and you will be subject to the retail copayment. Even if you elect to opt-out now, you can still choose to use mail service at any time.
You can choose the Select Active Choice by calling Express Scripts at 1-866-544-1798 or by logging into your account at www.express-scripts.com, and choosing “Manage Prescriptions,” then “Make Important Decisions.”
Do you have other health benefit questions? Send them to Chris Porter at firstname.lastname@example.org and put “Ask Chris” in the subject line. Chris is our Compensation and Benefit Research Specialist who will advocate for members experiencing challenges with their contracted medical benefits. We’ll post answers to commonly posed questions in this column.