Making the Moveto Express ScriptsYour new prescription drugcoverage begins Jan. 1, 2008.
Welcome to Welcome to Express Scripts, the company STRS Ohio has chosen to administer your prescription drug Express Scripts plan in 2008. Your coverage under Express Scripts will begin Jan. 1, 2008. In this booklet, you’ll find important information to make your transition to Express Scripts a smooth one. Please read this information carefully. If you have questions about your 2008 prescription drug coverage, please call Express Scripts toll-free at 1-866-685-2792. Representatives are available to assist you seven days a week, 24 hours a day. You can also visit http://member.express-scripts.com/preview/strs through Dec. 31, 2007, to learn about your coverage before it begins — compare drug costs, learn about preferred medications that can save you money, find participating retail pharmacies and more. Beginning Jan. 1, 2008, please visit www.express-scripts.com for more information about your prescription drug coverage. If you have specific questions about your STRS Ohio health care coverage, please call STRS Ohio’s Member Services Center toll-free at 1-888-227-7877. The center’s hours are Monday–Friday, 8 a.m.–5 p.m. You can also visit the STRS Ohio Web site at www.strsoh.org for more information. Please note that this booklet is an overview of your prescription drug coverage. It is not a legal docu- ment. You will receive a separate document that explains the terms of your coverage in a future mailing. | Making the Move to Express Scripts
Key Dates Express Scripts mails your new prescription ID card and coverage information. Your cover-Early December 2007 age under Express Scripts begins Jan. 1, 2008. Submit new prescriptions or refills to the Caremark mail-order pharmacy to ensure yourMid-December 2007 medications are dispensed by Dec. 31, 2007, under the 2007 copayments. First day you can send a new mail-order prescription to Express Scripts to be dispensedDec. 18, 2007 after Jan. 1, 2008, under the 2008 copayments. (Note: Express Scripts will return prescriptions received before Dec. 18.) Last day Caremark can dispense a mail-order prescription. After Dec. 31, most mail-orderDec. 31, 2007 prescriptions with refills remaining will be transferred to Express Scripts. • Express Scripts becomes your new prescription drug provider.Jan. 1, 2008 • Begin using your new ID card at retail pharmacies. • Begin using Express Scripts’ mail-order pharmacy. First day you can call Express Scripts to find out if your mail-order prescription with refillsJan. 5, 2008 remaining was successfully transferred to Express Scripts. Express Scripts toll-free 1-866-685-2792 |
Your New In December, Express Scripts will mail a welcome packet that contains your new prescription Prescription ID card and information about your prescription drug plan, including a mail-order form. You ID Card may have already received this packet. If not, it should arrive before your coverage begins. Below are a few details about your new ID card. • Two ID cards are issued per STRS Ohio account. • The first and last name of the primary cardholder are listed. The first names of covered dependents are also listed (no last names). • If a first or last name contains too many characters, it may not appear in its entirety on the ID card due to space limitations. This is okay. Express Scripts has your full name on file, which means your name will be recognized correctly at retail pharmacies and the mail-order pharmacy. (The last names of covered dependents will also be recog- nized even though they are not listed on the card.) • If you lose your ID card, please call Express Scripts toll-free at 1-866-685-2792 to request a new one. Express Scripts will issue a replacement card free of charge. • If you do not receive your new ID card by Dec. 21, 2007, please call STRS Ohio to check the status of your card. Until your new card arrives, you can present the notice on Page 5 to participating retail pharmacies so your prescriptions can be processed through Express Scripts. (For mail-order prescriptions, use the primary cardholder’s Social Security number in place of the cardholder ID number.) | Making the Move to Express Scripts
Notice to express scripts participatiNg pharmaciesAs of Jan. 1, 2008, STRS Ohio’s prescription drug plan will be administered by Express Scripts.To simplify your prescription processing, please link the cardholder and all family members toExpress Scripts. For Pharmacy Use Only Please follow the action steps listed below to enter the claim. Step 1 Enter Bin #: 003858 Step 2 Enter Processor Control: A4 Step 3 Enter Rx Group #: A8NA Step 4 Enter 9-digit member ID # (primary cardholder’s SSN) Step 5 Enter birthdate and gender of member receiving medicationNEED ASSISTANCE? Pharmacist, if you have questions while processing the claim, please call theExpress Scripts’ Pharmacy Help Desk toll-free at 1-800-824-0898. Express Scripts toll-free 1-866-685-2792 |
Automatic Most mail-order prescriptions with refills remaining will be automatically transferred to Transfer of Express Scripts from Caremark, with two exceptions — controlled substances and com- Mail-Order pounded medications. New mail-order prescriptions will be needed for these medications. Below are a few details to keep in mind. Prescriptions • Beginning Jan. 5, 2008, you can call Express Scripts to find out if your mail-order prescription was successfully transferred to Express Scripts. Transferred prescriptions will have new prescription numbers with Express Scripts. • Credit card information will not be transferred to Express Scripts. You will need to provide payment information to Express Scripts when you place your order. • Be sure to check the label of your current mail-order medication from Caremark. If no refills remain or the prescription has expired, you will need to obtain a new prescrip- tion from your physician to send to Express Scripts. • If you are currently taking a generic medication, there could be a change in drug appearance, as Express Scripts may use different generic drug manufacturers. Where You Can Beginning Jan. 1, 2008, you can purchase covered prescription medications for a copayment Purchase through participating Express Scripts retail pharmacies and Express Scripts’ Home Delivery Prescription Program. You can also purchase specialty medications through CuraScript, Express Scripts’ specialty pharmacy. Drugs | Making the Move to Express Scripts
Where You CanparticipatiNg retail pharmaciesWhen you purchase your prescriptions through a participating retail pharmacy, you present Purchaseyour Express Scripts ID card and pay a copayment at the time of purchase. (If the cost of the Prescriptiondrug is less than the copayment, you will pay only the cost of the drug.) You do not need tosubmit a claim form to Express Scripts. Drugs (continued) • Both chain and independent pharmacies make up the retail network of participating Express Scripts pharmacies within Ohio and nationwide. Please check to make sure your retail pharmacy is part of Express Scripts’ participating network. For a list of participating retail pharmacies, call Express Scripts toll-free at 1-866-685-2792 or visit Express Scripts’ Web site. • If you choose a nonparticipating retail pharmacy, you pay the full price of the prescrip- tion at the time of purchase. After you submit a claim form to Express Scripts, you will be reimbursed the amount STRS Ohio would have been charged had you used a participating retail pharmacy, less the applicable copayment.home Delivery programYour prescription drug plan includes a convenient mail-order option. When you purchaseyour prescriptions through the Express Scripts Home Delivery Program, you pay a copay-ment at the time of purchase. You do not need to submit a claim form to Express Scripts. Yourprescriptions will be delivered to you by mail approximately 10 to 14 days after Express Scriptsreceives your order. See Page 8 for details. Express Scripts toll-free 1-866-685-2792 |
Where You Can Using Home Delivery Purchase • New prescriptions — To order a new mail-order prescription, submit a completed Prescription Home Delivery form to Express Scripts. A Home Delivery form is included in the welcome packet from Express Scripts. For additional forms, please call Express Scripts Drugs toll-free at 1-866-685-2792. (Note: The Home Delivery form is a postage-paid self- (continued) mailer, which means you do not need a separate envelope to mail it.) • Refills — To order refills, call Express Scripts toll-free at 1-866-685-2792 or visit www.express-scripts.com beginning Jan. 1, 2008. • Payment options — You can use a credit card, check card, check or money order to pay for your medication when you place your order. (Note: Your order could be delayed if you do not submit payment.) • Notification options — You can choose to have Express Scripts notify you when your mail order has been shipped. Notification options include an automated phone call or e-mail message. If you want to be notified, please call Express Scripts to activate this option. curascript specialty pharmacy Under your prescription drug program, you can order specialty medications through CuraScript, Express Scripts’ specialty pharmacy. To make the transition to CuraScript easy, refills for specialty medications on file with Caremark’s specialty or mail-order pharmacy will be automatically transferred to CuraScript effective Jan. 1, 2008. A CuraScript representative will call you when your prescription is available for refill. For more information, please call CuraScript toll-free at 1-866-848-9870. (Note: If you are taking a specialty medication, you will receive more information about CuraScript in the mail.) | Making the Move to Express Scripts
Your copayments vary depending on the tier status of your medication and whether Your Prescriptionyou use a participating retail pharmacy or the Home Delivery Program. You will save Drug Copaymentsmoney by using generics and Tier 2 drugs. To check the tier status of a medication or theestimated price of a mail-order prescription, please call Express Scripts toll-free at1-866-685-2792 or visit Express Scripts’ Web site.The copayments listed below apply to all medication classes, except proton pump inhibitor(PPI) medications. Copayments for PPI medications, such as Nexium®, are listed inparentheses. Participating Retail and Home Delivery Program Medication Tier Status Nursing Home Pharmacies (up to a 90-day supply) (up to a 30-day supply) Tier 1 (generic) $10 ($25 PPI) $25 ($65 PPI) Tier 2 (preferred brand-name) $30 ($50 PPI) $75 ($125 PPI) Tier 3 (nonpreferred $50 ($75 PPI) $125 ($190 PPI) brand-name) $5 with prescription Prilosec OTC® (up to 40 mg) Not covered (up to a 28-day supply) If the cost of the drug is less than the copayment, you will pay only the cost of the drug.Note: If you are enrolled in the Health Care Assistance Plan, your copayments will be lessthan those listed above. Please call Express Scripts for your copayment amounts. Express Scripts toll-free 1-866-685-2792 |
Reducing Your use geNerics aND tier 2 Drugs Prescription Under your prescription drug plan, you will pay less for generics and Tier 2 preferred brand- Drug Costs name drugs compared to Tier 3 nonpreferred brand-name drugs. This is why you should talk to your doctor about using generics or Tier 2 drugs whenever possible. • Generics and Tier 2 medications appear on a preferred list of drugs recommended by your plan. These medications are chosen for their clinical effectiveness and economic value based on the professional advice of pharmacists and a group of independent doctors. • To check the tier status of a medication, call Express Scripts toll-free at 1-866-685-2792 or visit Express Scripts’ Web site. • Talk with your doctor about prescribing drugs that are on your plan’s preferred list of medications. Using Tier 2 medications that appear on this list will save you money. Using generics will save you even more. • Remember, it’s important to take your medication as your doctor advises. Only you and your doctor can decide which medications are right for you.10 | Making the Move to Express Scripts
Reducing Yourpay less for prilosec otc®Under your prescription drug plan, Prilosec OTC® is available for a lower copayment than Prescriptionother Tier 1, Tier 2 and Tier 3 proton pump inhibitor (PPI) medications. PPIs, such as Drug CostsNexium®, are a class of medications primarily used to treat frequent heartburn and (continued)Gastroesophageal Reflux Disease (GERD). • Beginning Jan. 1, 2008, you can purchase a 28-day supply of Prilosec OTC® 20 mg tablets for $5 with a prescription through participating retail pharmacies. If you need a daily dose of 40 mg, your physician can write a prescription for two 20 mg tablets per day for a 28-day supply, and you will still pay only $5. • The following example shows the savings a Nexium® user can achieve by switching to Prilosec OTC® in 2008. (Note: Nexium® is a Tier 2 drug.) Medication Monthly Cost Annual Cost Annual Savings Retail: $50 Retail: $600 Nexium® None Mail: $125 Mail: $500 Prilosec OTC® $540 compared to Nexium® at retail Retail: $5 Retail: $60 (up to 40 mg) $440 compared to Nexium® through mail • Talk with your doctor about Prilosec OTC®. If your physician writes a prescription for Prilosec OTC®, be sure to ask how much time is needed for your body to adjust to the new medication, as transition times may vary by individual. • Be sure the prescription is written for Prilosec OTC® (not Prilosec®) to receive the special pricing under your prescription drug plan. Express Scripts toll-free 1-866-685-2792 | 11
Reducing Your use home Delivery for maiNteNaNce meDicatioNs Prescription You can save money by using the Home Delivery Program for maintenance medications. Drug Costs When you use home delivery, you receive up to a 90-day supply of medication for less than (continued) you would pay for three 30-day supplies at retail. Your annual savings with home delivery are listed below: • Tier 1: Save up to $20 ($40 PPI) per year. • Tier 2: Save up to $60 ($100 PPI) per year. • Tier 3: Save up to $100 ($140 PPI) per year. participate iN the voluNtary tablet-splittiNg program Your prescription drug plan offers a voluntary tablet-splitting program that allows you to save money by using double-strength medications. • Under the program, designated generic and brand-name medications can be pre- scribed at double the strength and split in half by the recipient to get the prescribed lower strength. For example, if you require 40 mg of a designated medication daily, your doctor can write a prescription for 80 mg tablets, which you can split in half to get the prescribed daily dose of 40 mg. • When split correctly, designated medications maintain their chemical effectiveness. Not all medications can be split. This is why STRS Ohio has worked with Express Scripts to develop a designated list of medications that are therapeutically safe and effective when split correctly.1 | Making the Move to Express Scripts
• If you are taking a medication on the designated tablet-splitting list, talk to your doctor Reducing Your about tablet splitting. If you and your doctor agree that tablet splitting is right for you, Prescription your doctor can write a prescription for double the strength of the medication, 15 tablets for a 30-day supply at retail or 45 tablets for a 90-day supply at mail. Drug Costs (continued) (Note: Your doctor must specify on the prescription that you will take half a tablet once a day.) • The medications on the designated tablet-splitting list are available for half the appli- cable copayment, up to half the quantity of the maximum day supply. When split correctly, 15 tablets of medication will last for 30 days and 45 tablets of medication will last for 90 days. 2008 Tablet-Splitting Copayments Participating Retail Pharmacies Mail-Order PharmacyMedication Tier Status (15 tablets for a 30-day supply) (45 tablets for a 90-day supply) Tier 1 $5 $12.50 Tier 2 $15 $37.50 Tier 3 $25 $62.50 If the cost of the drug is less than the copayment, you will pay only the cost of the drug. • Remember, when tablet splitting is done correctly on appropriate medications, each half of the tablet contains approximately equal amounts of active ingredients, which means you receive the prescribed dose of medication. (Note: Ask your doctor or phar- macist about the best way to split your tablets.) Express Scripts toll-free 1-866-685-2792 | 1
Reducing Your Below is the list of designated generic and brand-name medications that can be split under Prescription the 2008 voluntary tablet-splitting program. For more information, please call Express Scripts Drug Costs toll-free at 1-866-685-2792 or visit www.express-scripts.com beginning Jan. 1, 2008. Note: This (continued) list is subject to change. Drug Brand Name (Generic Name) Available Strength(s) Brand-Name Drug (Generic Drug) Tier Status Atacand® 8 mg, 16 mg, 32 mg Tier 3 Avapro® 150 mg, 300 mg Tier 3 Benicar® 40 mg Tier 3 Cozaar® 50 mg, 100 mg Tier 2 Crestor® 10 mg, 20 mg, 40 mg Tier 2 Diovan® 80 mg, 160 mg, 320 mg Tier 2 Lipitor® 20 mg, 40 mg, 80 mg Tier 2 Mevacor® (lovastatin) 20 mg, 40 mg Tier 3 (Tier 1) Micardis® 40 mg, 80 mg Tier 3 Norvasc® (amlodipine) 5 mg, 10 mg Tier 3 (Tier 1) Paxil® (paroxetine) 20 mg, 40 mg Tier 3 (Tier 1) Pravachol® (pravastatin) 20 mg, 40 mg, 80 mg Tier 3 (Tier 1) Prinivil® (lisinopril) 5 mg, 10 mg, 20 mg Tier 3 (Tier 1) Viagra®* 50 mg, 100 mg Tier 3 Zestril® (lisinopril) 5 mg, 10 mg, 20 mg, 40 mg Tier 3 (Tier 1) Zocor® (simvastatin) 10 mg, 20 mg, 40 mg, 80 mg Tier 3 (Tier 1)1 | Making the Move to Express Scripts *Quantity limits apply.
Getting More Who to Contact Phone Number Web Site Information Within the U.S. 1-866-685-2792 (toll-free) http://member.express-scripts.com/preview/strs Everyday, 24 hours a day (through Dec. 31, 2007) Express Scripts Outside the U.S. www.express-scripts.com (952) 820-7000, ext. 378710 (beginning Jan. 1, 2008) Everyday, 24 hours a day CuraScript 1-866-848-9870 (toll-free) (Express Scripts’ Weekdays, 8 a.m.–9 p.m.; www.curascript.com Specialty Pharmacy) Saturday, 9 a.m.–1 p.m. 1-888-227-7877 (toll-free) STRS Ohio www.strsoh.org Weekdays, 8 a.m.–5 p.m.12-550, 11/07/90M Express Scripts toll-free 1-866-685-2792 | 1