IQVIA Benefits Handbook
USING A RETAIL NETWORK PHARMACY
When you need a prescription filled for short-term medications, simply present your ID card. To find a retail network pharmacy near you or to see if your pharmacy is in the network, go to www.express-scripts.com. For Kaiser, https://healthy.kaiserpermanente.org/. When you use a retail network pharmacy:
- Your purchases are limited to a 30-day supply for each prescription filled.
- After the first two 30-day fills at a retail pharmacy, maintenance drug products must be filled in an amount equal to a consecutive 90-day supply per prescription order through the mail order pharmacy (or the CVS Smart90 program if you have Express Scripts). Otherwise, the Plan will not cover the maintenance drug product.
- You will not need to file a claim (unless you don't have your ID card with you when you fill your prescription). If you do not show your ID card at a network pharmacy, you will have to pay 100% of the cost for the prescription and then file a claim form for reimbursement. The plan will reimburse you for the submitted amount less the applicable copay/coinsurance. You can call Express Scripts or Kaiser to get your plan information while you are at the pharmacy if you don't have your ID card.
The Plan does not provide coverage when you use a non-network pharmacy.