Frequently Asked Questions
What is the Drug Choice Management Program?
The Drug Choice Management Program consists of select nonpreferred
products and their preferred alternatives. These products are taken
from selected therapy classes chosen by Express Scripts.
What
if a member has a prescription (new or refill) for a nonpreferred
product?
The prescription will be rejected with the following message: "NONPREF,
Disp [preferred product name] or resend orig RX." Please call
the prescriber for authorization to change to the preferred product.
What
if the prescriber is unavailable or denies the change?
Simply retransmit the nonpreferred prescription claim for payment.
This second transmission will be accepted.
What
if the nonpreferred product is dispensed?
The prescriber will then receive a fax from Express Scripts requesting
authorization for the next fill to be switched to the preferred
product. Once the change is authorized, the prescriber will notify
Express Scripts and contact your pharmacy with a new prescription
for the preferred product. The member will be notified that the
change has been authorized and the pharmacy has been contacted.
What
if the member accidentally requests the nonpreferred product after
the preferred product is authorized?
You'll receive the following nonpreferred reject message: "MD
approved switch to [preferred product name]." If you have not
received the new preferred prescription, please contact the prescriber.
What
is the incentive for the pharmacy?
Select sponsors designated by Express Scripts as participants in
the Preferred Product Incentive Program are reimbursed up to $12
per year for each formulary product.
What
are the steps for processing Betaseron claims?
All Betaseron claims should be submitted online to HDS Bin#610500,
not to Express Scripts. Inquiries should be directed to HDS at 800.750.9835.
What
is the standard Express Scripts remittance cycle?
Express Scripts dispenses payment twice a month on the average of
30 days. For independent pharmacies and Diversified Pharmaceutical
Services, Inc. claims, checks and remittances are mailed separately
within 2 weeks of each other. Generally, the check is mailed first.
How
do I request a copy of a previous remittance?
Fill out our remittance copy request and a copy will be sent to
you.
What
is the turnaround time if I request a copy of a check?
You should receive the check copy within 2 weeks of the request
date.
Is
there a fee for a check copy?
Check copies are subject to a $25 per check fee (subject to change).
How
do I request a copy of a check?
Complete our check copy request and a copy will be sent to you.
How
can I determine whether or not a claim has been paid?
Refer to your remittance for all payment information. If necessary,
you can complete our claim status request to obtain further information.
A request involving more than 10 claims may be subject to an investigation
fee.
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