Claims and Inquiries
Express Scripts is the Claims Administrator for the Prescription Drug Plan. Under this Plan, a network of retail pharmacies is available as well as mail-order prescription drug coverage. When you go to a participating retail pharmacy, simply present your identification card and pay the appropriate coinsurance.
If you use a non-participating pharmacy, you will be responsible for paying the full cost of the prescription to the pharmacist, and then filing a claim for reimbursement. Claim forms are available by calling Express Scripts at 800-718-6590 or at Express Scripts' website at www.express-scripts.com.
In accordance with federal law, all claims for prescription drugs, except controlled substances, must be made within twelve months of the date on which the prescription was written by the physician. If you do not file a claim within this timeframe, your claim will be denied. Federal law also requires that all claims for controlled substances must be made within six months of the date on which the prescription was written by the physician.
If you have an issue or complaint regarding your prescription drug benefits, you should first address your concerns with Express Scripts within 60 days after the issue or complaint arises. Many problems, complaints, and potential claim issues can be resolved informally. You can address these informal complaints by phoning Express Scripts at 800-718-6590. Express Scripts may ask you to provide additional information or ask your physician to do so, or may try to clarify any information already provided. Express Scripts will research your issue and respond to you on its findings either in writing or by telephone within 15 days for prescriptions that have not been filled, and within 30 days for prescriptions that have already been filled and paid for.