Choosing a pharmacy or home delivery
We expect that the drugs on the Approved Drug List (formulary) for your plan will meet all your prescription drug needs. However, if your doctor prescribes a drug that's not on your plan's Approved Drug List, we may still approve it for you.
Here's the process for asking for an exception to the formulary:
- Your doctor will fill out a drug authorization request form that explains why you need the non-formulary drug.
- Priority Health will let you and your doctor know, within 24 hours of receiving all information we need to make a decision, whether or not we approve the drug for you.
- If you are not happy with the determination, you or your representative have the right to request a decision by an Independent Review Organization (IRO).
- Priority Health has 72 hours to get an IRO decision, or 24 hours to get an IRO decision if waiting 72 hours may seriously jeopardize your life or health or your ability to regain maximum function or when you are undergoing a current course of treatment using a non-formulary drug. Priority Health will cover the non-formulary drug during the review period and for as long as required by law.
If you're on a daily medication, then using our home delivery pharmacy, Express Scripts, will save you many trips to the pharmacy.
- Regular shipping is free.
- Your first order will arrive within 14 days of when Express Scripts receives it.
- Refills arrive in 7 to 10 days.
Send in one prescription a year
For most medications, just send in your doctor's prescription form for a one-year supply (a 90-day supply with 3 refills). Use the Express Scripts Home Delivery Order Form. Express Scripts will ship you a 90-day supply and a form for requesting your refills. You can also set up an online account (see below) and set up automatic refills.
Refills are easy
After you receive your first order, life's even easier. Just go to express-scripts.com and click a button to order your refill (or set up automatic refills). Or you can call to order your next 3-month supply. Have the prescription label with you when you order refills, because you'll need the numbers on it.
When you have no refills left, Express Scripts will call your doctor to find out if your prescription should be renewed.
Order prescriptions online:
Visit express-scripts.com to:
- Register your account (use the same ID number found on your Priority Health membership card)
- Order new prescriptions (delivered free within 14 days)
- Set up auto refills
- Order refills (delivered within 7 to 10 days)
- Pay with your American Express®, Discover Card®, MasterCard® or Visa®.
Order by phone:
Call Express Scripts at 888.378.2589.
Order by mail:
- Fill in an Express Scripts Home Delivery Order Form. Attach your prescription.
- Send a check or money order payable to Express Scripts when you send in the order form. If paying by check, include the following information: Your name and the name of the dependent whose prescription you are filling, address, phone number, and one of the following: Previous order number, prescription number, invoice number, Priority Health member ID number.
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