Members with the Exclusive Home Delivery benefit feature are required to use Express Scripts, Inc.’s (ESI) Mail Service Pharmacy or an approved retail pharmacy to fill certain maintenance medications.
Members should fill the prescriptions twice at retail before using the mail service pharmacy in case adjustments to their medications are needed (such as with newly prescribed medications).
Members will pay the mail order cost share for a 90-day supply of their medication.
This helps lower the overall cost of prescription medications for our members since ESI is able to offer significantly better discounts for the cost of these medications through mail order than at a retail pharmacy.
Exclusive Home Delivery is a benefit option for many HMO Blue products (except HMO Blue New England) and for our self-insured employers.
Since home delivery using ESI’s Mail Service Pharmacy may not work for all of our members, we also allow them to fill their maintenance medications at one of these retail pharmacies.
*An example of a provider-based pharmacy is one found in a community health center.
Adjustments in medications may be required
We recognize that sometimes new prescriptions require adjustments to the medication or dosage. That’s why we encourage prescribers to have members fill initial 30-day prescriptions at a retail pharmacy to avoid any medication waste.
After each of the first two courtesy fills, the member will receive a letter from ESI reminding them of their Exclusive Home Delivery benefit. Further refills will not be covered at the retail (or provider-based) pharmacy. To transition to the Mail Service Pharmacy prior to the third fill, members must either:
Here are some answers to frequently asked questions about the Exclusive Home Delivery benefit feature.
If your patient has this benefit and you prescribe one of the medications on our Maintenance Medication List, the member will receive a letter after his/her first two fills at a retail (or provider-based) pharmacy. The letter asks members to contact their health care provider to send their prescription to mail-order.
We recognize that newly prescribed medications may need to be adjusted by the prescriber for a variety of reasons, which is why those first two prescriptions may be filled at a retail (or provider-based) pharmacy to prevent medication waste.
Our goal is to offer a safe and more affordable pharmacy benefit for our members, but we recognize that some patients may have unique clinical circumstances and we rely on your clinical judgment. If you have a safety concern about prescribing a 90-day supply of a specific medication on our Maintenance Medication List, we can work with you to discuss the best approach. Please contact our Clinical Pharmacy Operations team at 1-800-366-7778.
Regarding safety, studies have shown that patients who receive medications at mail order are more likely to adhere to their prescribed treatment regimen and, with the use of automated technology, mail order pharmacies have fewer dispensing errors than retail pharmacies.