If a coverage review is required, your pharmacy will receive an alert. This means that more information is needed from your doctor to see if your plan covers the medication.
Ask your doctor to either call Express Scripts to request a coverage review or to prescribe an alternative medication that’s covered by your plan. After Express Scripts receives a prior authorization request, then a review begins. Only your doctor can provide the necessary information for a coverage review.
You can track the status of your coverage review and get helpful information about the process online or through our mobile app. Log in and go to Prior Authorizations under Prescriptions.
If you receive coverage approval, your prescription will be filled like normal. If coverage is not approved and you don’t want an alternative medication, you have the option to pay full price for the prescription.
To help avoid a coverage review, ask your doctor if they’re connected to Real-Time Prescription Benefit so they can check if your medication is covered by your plan before you try to fill it. You can also use your online account or our mobile app to check pricing and coverage.