link to myflorida.com homepage
spacer
 
   

   

Health

State PPO

HMO

Life Insurance

Dental

Vision

Supplemental

   

Frequently Asked Questions about the Prescription Drug Plan

Questions

Medco, owned by Express Scripts, administers the pharmacy benefits for the State Employees' Prescription Drug Plan.

1. What if I go to the pharmacy without my Medco ID card?

2. What happens if I use an out-of-network pharmacy, such as Walgreens?

3. What if I have manufacturers' discount cards or coupons?

4. What if I cannot afford to pay the entire mail-order copay upfront for a 90-day prescription?

5. How should my provider write my mail-order prescription?

6. Can Medco transfer my prescriptions from a retail pharmacy to the Medco mail-order pharmacy?

7. Which medications am I required to fill through mail-order?

8. What are examples of medications that do not need to be filled through mail-order?

9. How long does it take to get my medications when I use mail-order?

10. How are medications shipped?

11. How do I get started with the Medco mail-order pharmacy?

12. Is there a service that allows for automatic refills through mail order so I do not have to remember to order my refills?

13. How do I know whether my medication is covered or if there is a generic equivalent?

14. What are the different payment methods accepted by the mail-order pharmacy?

15. What if I don't want generic substitutions for my prescription?

16. When my provider faxes a prescription to the Medco mail-order pharmacy, what happens?


Answers


1. What if I go to the pharmacy without my Medco ID card?

You can download Medco's free smartphone app to use your ID card or tell the pharmacist that your prescription drug plan uses Medco. The pharmacist can call Medco to verify your coverage and fill the prescription.

(back to top)


2. What happens if I use an out-of-network pharmacy, such as Walgreens?

If you're in the State Employees' PPO Plan, you may file a claim and be reimbursed for the out-of-network provider benefit, as defined in the Benefit Document.

If you are an HMO member, you only have access to network prescription drug benefits, so you would pay the entire cost of the medication out of pocket.

(back to top)


3. What if I have manufacturers' discount cards or coupons?

Discount cards or coupons are not to be used in conjunction with the State Employees' Prescription Drug Plan.

(back to top)


4. What if I cannot afford to pay the entire mail-order copay upfront for a 90-day prescription?

Medco offers a payment plan option using a debit or credit card. You may pay three monthly installments for a prescription with no interest or service fees. Call Medco Member Services toll-free at (877) 531-4793 for more information.

(back to top)


5. How should my provider write my mail-order prescription?

Ask your provider to write your prescription for up to a 90-day supply with refills for up to a year, when appropriate. If your provider writes the prescription for a 30-day supply, you must still pay the 90-day supply copay.

The actual quantity and/or days' supply may vary for each drug. Your provider's instructions on how to take the medication, state and federal dispensing guidelines or how the medication is packaged may impact the quantity and/or days' supply you can receive.

(back to top)


6. Can Medco transfer my prescriptions from a retail pharmacy to the Medco mail-order pharmacy?

Sure. For many existing retail prescriptions, you can log into Medco or call Medco Member Services at (877) 531-4793 to request a new mail order prescription from your physician. Go to the Order Center to take advantage of mail order savings opportunities and lower-cost medication alternatives.

(back to top)


7. Which medications am I required to fill through mail-order?

If you are enrolled in the PPO Plan, you must fill your maintenance medications through the Medco mail-order pharmacy after three fills at a retail pharmacy. Maintenance medications are typically used to treat chronic conditions that require regular or on-going use of medicines (e.g. hypertension, diabetes, high cholesterol, asthma).

HMO members are not required, but are encouraged, to use mail order because of the cost savings and convenience.

(back to top)


8. What are examples of medications that do not need to be filled through mail-order?

Go to your local, network retail pharmacy for acute medications that are taken for a limited time for a short-term condition, such as antibiotics for a sinus infection, ear infection, strep throat, etc.

(back to top)


9. How long does it take to get my medications when I use mail-order?

For first-time mail-order prescriptions, your medication will usually be delivered within eight days after Medco receives your complete and accurate prescription. If you are requesting a mail order refill, please be sure to have at least a 14-day supply on hand when ordering.

Refills are usually delivered within three to five days after Medco receives your request.

When it is time to reorder, log into www.medco.com . Go to the Order Center and click the box next to your medication or set up the Worry-free Fill Program. The best time to reorder is when you have about a 14-day supply of your medication remaining. Your prescription is eligible for a refill when 75 percent should have been used if taken as prescribed. If you request a refill too soon, your prescription will be held until it is time to be refilled.

The most up-to-date information on your refill is available online.

Certain medications, including drugs prescribed for narcolepsy, attention deficit disorder, and pain management, require a signature upon delivery.

(back to top)


10. How are medications shipped?

Most medications are shipped via the U.S. Postal Service at no cost to you. Medications containing certain controlled substances are shipped United Parcel Service (UPS). If necessary, you can request express shipping for an additional fee. Shipment of some medications must be scheduled and delivered to a physical address (not a post office box). Generally, these medications require additional packaging, such as cold packs, will be shipped for delivery within one to two days.

(back to top)


11. How do I get started with the Medco mail-order pharmacy?

Ask your provider to write a prescription for up to a 90-day supply, and have it sent to the Medco Pharmacy® one of three ways:

  • Mail your prescription and a completed mail order form to the Medco Pharmacy.
  • Ask your provider to ePrescribe, call in, or fax your 90-day prescription. Your provider can call (888) 327-9791 for instructions.
  • Ask Medco to transfer your prescription for you. Log into www.medco.com and click Order Center on the left-hand menu. Then locate your prescription under the "Transfer your retail prescriptions to the Medco Pharmacy" section and click the box next to your medication.
    • To order additional forms and envelopes, visit www.medco.com or call Member Services toll-free at (877) 531-4793. Have your member ID number available.
If you are a member of the State Employees' PPO Plan, you must use mail order for maintenance medications after filling the prescription three times at a retail pharmacy. If you continue to use a retail pharmacy after the third fill, you will be responsible for the full cost of the medication.

Please call Medco Member Services toll-free at (877) 531-4793 if you are currently receiving assistance from the Ryan White HIV/AIDS Program (provided by the federal HIV/AIDS Treatment Extension Act of 2009) or Florida Medicaid to avoid any inconvenience or interruption of the benefits provided through these programs.

(back to top)


12. Is there a service that allows for automatic refills through mail order so I do not have to remember to order my refills?

Yes, with the "Worry-free Fill Program," you can request automatic refills of certain medications on the appropriate refill date. You may also request a new prescription following the last refill after you have taken the medication for a minimum of 30 days.

Notifications of refills come in time to allow you to cancel the refill if you choose.

Call Medco Member Services toll-free at (877) 531-4793 for more information.

(back to top)


13. How do I know whether my medication is covered or if there is a generic equivalent?

Current members may log into www.medco.com to find coverage and pricing details and to find out if medication has a less expensive generic equivalent. Members may also call Medco Member Services 24/7 toll-free at (877) 531-4793.

Not yet a member? Visit www.medco.com/sofrxplan.

(back to top)

14. What are the different payment methods accepted by the mail-order pharmacy?

You can pay by check, e-check, money order or credit card (MasterCard, VISA, American Express or Discover). If you prefer to use a credit card, you have the option of joining the Medco automatic payment program. Call (877) 531-4793 or enroll online.

E-check is another term for electronic funds transfer. When you use e-check, the copayment or coinsurance amount you owe is deducted from your checking account 10 days after your order is sent. The amount deducted will be included in your prescription information that accompanies your order.

(back to top)

15. What if I don't want generic substitutions for my prescription?

If you request a preferred-brand drug when a generic is available, you must pay the difference between the two, plus the appropriate copayment or coinsurance. If your provider writes on the prescription that the preferred-brand drug is medically necessary or "dispense as written" and the reason, you pay only the appropriate copayment or coinsurance. Ask your provider to write the prescription for up to a 90-day supply with three refills, if appropriate.

(back to top)

16. When my provider faxes a prescription to the Medco mail-order pharmacy, what happens?

Medco will make sure that the prescription is coming from a secure fax machine associated with a prescriber listed in Medco's database. A secure fax machine is restricted from public access and is generally within a controlled area in the provider's office.

If Medco cannot determine the security of the fax line, or if the incoming fax number cannot be matched against a prescriber in Medco's database, Medco will contact the provider's office to verify your prescription.

If the prescription is verified, Medco processes the prescription.

Medco will contact you if the prescription cannot be verified by your provider. After two unsuccessful attempts to contact you, Medco will send you a notification stating that your prescription could not be filled due to lack of verification from your provider.

(back to top)