Pharmacy | 2022 | MedicalPharmacy – Retail & Delivery
How It Works
(Out-of-network pharmacy expenses are not covered. For specialty medications, see Pharmacy – Specialty Prescriptions.)
Prime Therapeutics is a national network comprised of thousands of retail pharmacies. The network includes most major chains, discount, grocery and independent pharmacies, so there is a good chance that your local pharmacy is a participating member of the network. To find a local pharmacy, visit www.myprime.com and click “Find a Pharmacy” or contact Member Services.
Express Scripts Pharmacy Contact
PO Box 66530
St. Louis MO 63166-6530
Express Scripts Pharmacy is designed for plan participants taking maintenance medications, or those medications taken on a regular basis, for the treatment of long-term conditions, such as diabetes, arthritis, or heart conditions. The program provides up to a 90-day supply of medication, delivered directly to your home, postage paid.
Express Scripts mobile app makes it easy manage your prescriptions:
- Refill prescriptions
- Track your order
- Make payments
- Set reminders to take medicine and more
In order to fill your prescription, please logon to the Express Scripts Pharmacy website at express-scripts.com/flblue for your order form and payment information. You may also ask your doctor to call 1-866-230-7261 for instruction about faxing in your prescription. Your medication will usually be delivered within five to seven days of Express Scripts Pharmacy receiving your order.
Note: Specialty Drugs are not available through the Mail Order Pharmacy.
To order refills, call Member Services at 1-800-664-5295, or visit express-scripts.com/flblue. Refills are normally delivered within three to five days. If you are a first-time visitor to the site, please take a moment to register and have your member ID and prescription number available.
To ensure timely delivery, place your orders at least two weeks in advance to allow for mail delays and other circumstances beyond our control. If you have any questions concerning your order, or if you do not receive your medication within the designated time frame, please contact Member Services.
If a new medication has been prescribed for you to take immediately, please ask your doctor to issue two prescriptions; one prescription should be written and filled at your local pharmacy and the second should be written for up to a 90-day supply. To fill the latter prescription, please logon to Express Scripts Pharmacy website at express-scripts.com/flblue for your order form and payment information.
As you manage your prescriptions, be aware that each prescription is filled and checked by highly qualified registered pharmacists to ensure that quantity, quality and strength are accurate. A patient profile is maintained on file to ensure that there are no adverse reactions with other prescriptions you are receiving from retail and/or mail order pharmacies. If any questions arise regarding potential drug interactions or other adverse reactions, Express Scripts Pharmacy’s pharmacists will contact either you or your doctor prior to dispensing the medication.
Prime Therapeutics is the current Pharmacy Benefit Manager for Duval County Public Schools.
Visit Prime Therapeutics’ website, www.myprime.com, to view your plan design and copayment information, search for details on prescription medications, locate a participating pharmacy near you, and manage your home delivery prescriptions. For additional plan inquiries, you may call Member Services directly at 1-800-664-5295. For future reference, this number is listed on the back of your Florida Blue ID card.
Benefit ID Cards
Present your ID card when filling a prescription at the pharmacy. Should you need additional or replacement ID cards, please contact Member Services or visit www.floridablue.com to either request a new card or print a temporary card.
Federal legend prescription drugs, unless otherwise indicated;
- Drugs requiring a prescription under the applicable state law;
- Insulin, insulin needs and syringes on prescription; or
- Compound medications, of which at least one ingredient is a federal legend drug.
Medication Step Therapy
Step Therapy requires the previous use of one or more drugs before coverage of a different drug is provided. If your health plan’s formulary guide reflects that Step Therapy is used for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense.
Prior authorization is required on some medications before your drug will be covered. If your health plan’s formulary guide indicates that you need a prior authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense.
Quantity limits are applied to certain drugs based on the approved dosing limits established during the FDA approval process. Quantity limits are applied to the number of units dispensed for each prescription. If your health plan’s formulary guide reflects that there is a quantity limit for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense.
Formulary exceptions are necessary for certain drugs that are eligible for coverage under your health plan’s drug benefit. Your physician must submit a formulary exception form to your health plan for approval. If the request is not approved by the health plan you may still purchase the medication at your own expense. The general form can be used if the drug you are requesting coverage for is not on the formulary list.
Prescription Copay Summary: Retail and Mail Order
Out of Network Retail and Mail Order Pharmacy expenses are not covered.
Note: Specialty Drugs are not available through Mail Order Pharmacy. For more information, please contact customer service at 800-664-5295.
|NON-CONTRIBUTORY PLAN||CONTRIBUTORY PLAN||HIGH DEDUCTIBLE HEALTH PLAN (HDHP)*|
|30-Day Supply||Calendar Year Deductible (CYD) MUST be met then:|
|Generic - Formulary||$7||$7||CYD + $7|
|Brand - Formulary||$25||$25||CYD + $25 + 10% Coinsurance|
|Non-Formulary||$40||$40||CYD + $40 + 10% Coinsurance|
|Specialty Injectables||$55||$55||CYD + $55 + 10% Coinsurance|
|90-Day Supply||Calendar Year Deductible (CYD) MUST be met then:|
|Generic - Formulary||$14||$14||CYD + $14|
|Brand - Formulary||$50||$50||CYD + $50 + 10% Coinsurance|
|Non-Formulary||$80||$80||CYD + $80 + 10% Coinsurance|
|*HDHP W/HSA: Rx costs go to deductible. Once deductible is met, then employee pays copay for generic and copay+10% for all other Rx.|