Coordination of Benefits
If you are covered by another plan that has prescription drug coverage that is primary to this Plan (see "If You Have Other Coverage" in the Health Care Participation section), you will need to fill out an Express Scripts Coordination of Benefits/Direct Claim Form in order to receive any benefit, if eligible, from Express Scripts. The form is available by calling Express Scripts Member Services at 800-718-6590.
You must submit a separate claim form for each pharmacy used and for each patient. You will need to attach documentation to the completed form. The documentation required depends on what plan is primary, as follows:
  • If the primary plan is another health plan, you must attach the claim statement, or Explanation of Benefits, which you received from the primary plan to the completed Express Scripts form.
  • If the primary plan is an HMO or another plan in which a co-payment or coinsurance is paid at the pharmacy, you will need to attach receipts that clearly show the amounts you paid at the pharmacy.
  • If the primary plan is another Express Scripts mail-order plan, you will need to attach either the prescription receipt or the statement of benefits you received from Express Scripts' mail-order pharmacy.
Complete instructions are included on the Express Scripts Coordination of Benefits/Direct Claim Form.