Express Scripts: A Comprehensive Guide to Your Prescription Benefits
What is Express Scripts?
Express Scripts is one of the largest pharmacy benefit managers (PBMs) in the United States. As a PBM, it works as a middleman between health insurance providers, pharmaceutical companies, and pharmacies to manage prescription drug benefits for insurance plans.
This in-depth guide explores everything you need to know about Express Scripts, from its services and benefits to how you can maximize your prescription savings.
Who Owns Express Scripts?
In 2018, Cigna Corporation acquired Express Scripts in a multi-billion-dollar deal, integrating its services into Cigna’s healthcare offerings. Today, Express Scripts operates as a subsidiary of Cigna and continues to provide PBM services to various insurance providers, employers, and government agencies.
How Express Scripts Works
Express Scripts simplifies medication access by managing drug coverage and providing home delivery pharmacy services. Here’s how it works:
- Prescription Management – Express Scripts partners with insurance companies to determine which medications are covered under a plan.
- Home Delivery Pharmacy – Members can receive maintenance medications via mail order, reducing trips to the pharmacy.
- Prior Authorization & Cost Control – Some drugs require approval before coverage kicks in, ensuring appropriate use.
- Formulary Management – Express Scripts maintains a list of preferred medications to keep costs manageable for patients and insurers.
- Medication Adherence Support – Tools like automated refills and reminders help patients take medications as prescribed.
Key Services of Express Scripts
1. Home Delivery Pharmacy
Express Scripts provides a home delivery service that allows members to receive up to a 90-day supply of maintenance medications at a lower cost than retail pharmacies. Benefits include:
- Convenience – No need to visit a pharmacy; medications are shipped to your doorstep.
- Cost Savings – Often, copays for mail-order prescriptions are lower than those for retail pharmacies.
- Medication Safety – Pharmacists review each prescription for potential interactions or safety concerns.
2. Express Scripts Mobile App & Website
Express Scripts offers a mobile app and online portal, allowing members to:
- Order refills and track shipments
- View prescription history
- Compare drug prices
- Set up automatic refills and reminders
3. Express Scripts Pharmacy Benefits
Express Scripts members enjoy a range of pharmacy benefits, including:
- Access to a nationwide network of pharmacies, including major chains like CVS, Walgreens, and Walmart
- Preferred pricing on generic and brand-name drugs
- Specialty pharmacy services for chronic and complex conditions
4. Express Scripts Specialty Pharmacy
For patients with chronic or rare conditions requiring high-cost medications, Express Scripts has a specialty pharmacy that provides:
- Expert support from pharmacists trained in specialty medications
- Financial assistance programs to help manage high drug costs
- Personalized medication management plans
How to Sign Up for Express Scripts
If your employer or insurance provider offers Express Scripts, enrolling is simple:
- Check Your Eligibility – Visit the Express Scripts website and enter your insurance details.
- Create an Account – Sign up online or via the mobile app.
- Transfer Prescriptions – If you have existing prescriptions, Express Scripts can transfer them from your local pharmacy.
- Set Up Home Delivery – If you take maintenance medications, enroll in mail-order services for added convenience.
How to Use Express Scripts to Save Money on Prescriptions
1. Choose Generic Drugs When Possible
Generic medications are significantly cheaper than brand-name drugs but contain the same active ingredients. Express Scripts promotes generic alternatives to help members save on prescription costs.
2. Use Home Delivery for Long-Term Medications
Ordering a 90-day supply through Express Scripts home delivery pharmacy is often cheaper than filling 30-day supplies at a retail pharmacy.
3. Compare Drug Prices
Express Scripts provides a drug price comparison tool on its website and app, helping members find the most affordable option for their prescriptions.
4. Apply for Patient Assistance Programs
Some pharmaceutical companies offer financial assistance programs for expensive medications. Express Scripts can help members connect with these programs.
Express Scripts and Medicare
If you’re a Medicare beneficiary, Express Scripts may manage your Medicare Part D prescription drug plan (PDP). Benefits of using Express Scripts for Medicare include:
- Lower copays for preferred medications
- Coverage for a wide range of prescriptions
- Access to Express Scripts’ mail-order pharmacy
To check if your Medicare plan includes Express Scripts, visit the Medicare website or Express Scripts’ official portal.
Express Scripts vs. Competitors
Express Scripts is a leading PBM, but it competes with several other major pharmacy benefit managers:
| Feature | Express Scripts | CVS Caremark | OptumRx |
|---|---|---|---|
| Mail-Order Pharmacy | ✅ Yes | ✅ Yes | ✅ Yes |
| Specialty Pharmacy | ✅ Yes | ✅ Yes | ✅ Yes |
| Drug Price Comparison Tool | ✅ Yes | ✅ Yes | ✅ Yes |
| Mobile App for Easy Refills | ✅ Yes | ✅ Yes | ✅ Yes |
Common Issues & How to Solve Them
1. Prescription Delays
Solution: Track your shipment through the Express Scripts website or app. If there’s a delay, contact customer service for updates.
2. Prior Authorization Issues
Solution: Some medications require prior authorization from your doctor. Your physician can submit the required documentation to expedite approval.
3. High Out-of-Pocket Costs
Solution: Check if a generic alternative is available or explore patient assistance programs. Express Scripts customer support can help find cost-saving options.
Customer Reviews & Satisfaction
Express Scripts has mixed customer reviews, with some praising its cost-saving features and others citing issues with delayed shipments or prior authorization hurdles. However, the majority of members appreciate:
- The convenience of mail-order services
- Lower prescription costs compared to retail pharmacies
- 24/7 access to pharmacists for medication-related questions
Final Thoughts
Express Scripts is a powerful tool for managing prescription benefits efficiently and affordably. Whether you’re looking to save on drug costs, access medications more conveniently, or receive specialized support for complex conditions, Express Scripts offers comprehensive solutions.
By leveraging its home delivery pharmacy, cost-comparison tools, and specialty medication services, you can maximize the benefits of your prescription drug coverage. If Express Scripts is part of your insurance plan, taking full advantage of its features can help you achieve better health outcomes while saving money on your medications.
1. How do I refill a prescription with Express Scripts?
To refill a prescription, log in to your Express Scripts account via their website or mobile app. Select the medication you need to refill, choose your delivery option, and place the order. You can also set up automatic refills for maintenance medications.
2. What should I do if my medication requires prior authorization?
If your medication requires prior authorization, your doctor will need to submit a request to Express Scripts. You can check the status of the approval on the Express Scripts website or app. If there are delays, contact your doctor’s office to ensure the necessary paperwork has been submitted.
3. Can I use Express Scripts if I prefer to pick up my medications at a local pharmacy?
Yes! Express Scripts has a nationwide network of retail pharmacies, including major chains like Walgreens, CVS, and Walmart. When filling a prescription, present your Express Scripts member ID card to receive discounted pricing.