Express Scripts, Inc. (ESI) administers the benefits and offers a broad choice of covered drugs through a nationwide pharmacy network. Subscribers will receive a separate prescription ID card upon enrollment. Contact ESI for more information.
Reserved Rights — MCHCP reserves the right to pay only for those medications prescribed by a physician, filled at an assigned pharmacy, and approved by MCHCP if drug misuse, abuse or fraud is suspected.
Preauthorization — ESI requires preauthorization for specific medications. This means proof of medical necessity is required before a prescription for certain drugs is paid for by the plan. The purpose is to prevent misuse and off-label use of expensive and potentially dangerous drugs. If preauthorization is required, member’s physician should call ESI's Preauthorization line at 800-417-8164.
Quantity Level Limits — Quantities of some medications may be limited based on recommendations by the Food and Drug Administration (FDA) and medical literature. Limits are in place to ensure safe and effective drug use and to guard against stockpiling of medicines.
Compound Prescription Drugs — Members filling compounded medication prescriptions will receive notification from ESI if their prescription is not covered. The notification lists ingredients in the specific compounded medication(s) which are not covered because they are not approved by the FDA. MCHCP does not cover investigational, experimental or non-FDA approved products; therefore, ESI cannot process and pay claims for certain compound prescription drugs.
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