Plan Member Frequently Asked Questions

The following questions address issues that will be of concern to employees whose company or organization provides them with a health benefits package that includes home delivery of maintenance medications from the Express Scripts Canada Pharmacy:

What is home delivery from the Express Scripts Canada Pharmacy?

The Express Scripts Canada Pharmacy dispenses maintenance medications – prescription drugs to treat ongoing medical conditions – taken by you and your covered family members. A supply of up to 90 days of these medications will be delivered to your home, or designated address, via free standard shipping, in a timely, convenient and affordable manner.

Where will Express Scripts Canada Pharmacies be located?

Express Scripts Canada will operate pharmacies throughout Canada. The Ontario pharmacy started to ship prescriptions to residents of Ontario on December 1, 2011. Other Express Scripts Canada Pharmacy locations are expected to open throughout 2012.

What are the benefits of using home delivery from the Express Scripts Canada Pharmacy?

There are many potential benefits to receiving maintenance medications for you and your dependents from the Express Scripts Canada Pharmacy:

Savings. Save money by ordering up to a 90-day supply of your maintenance medications.
Safety. The Express Scripts Canada Pharmacy’s licensed pharmacists check every prescription and shipment for accuracy and potential drug interactions.
Service. You will have access to speak privately with a licensed pharmacist whenever you need assistance.
Convenience. Prescriptions are delivered, via free standard shipping, right to your door, eliminating trips to your retail pharmacy. And it’s easy to sign up and order refills by phone, by mail or online.

What if I don’t currently take any maintenance medications? Should I register anyway?

Yes. You cannot always predict if and/or when you, or any of your family members, may require prescription medications for the treatment of a chronic medical condition.

Are others in my family eligible?

The program is available to all family members who are covered by your plan sponsor’s benefits plan.

Is co-ordination of benefits with a spouse’s plan allowed?

Yes. Initial payment is always directed through the cardholder’s drug card, and subsequently through a spouse’s plan. Whoever the patient is will dictate which card is processed first. For children or dependents, the card that is processed first is the parent who has the earliest birthday in the calendar year. Then the balance is processed through the parent’s plan whose birthday comes later in the year. When you enrol, you will provide information to the Express Scripts Pharmacy about any other coverage you may have, so that both plans will be charged appropriately.

Will I receive a receipt for the outstanding balance paid for drugs to use to co-ordinate benefits with other insurance plans?

If the pharmacy has information on both drug cards, both plans can be billed electronically and payments will be charged in real-time. Any outstanding balance from either drug plan will be charged to you as a co-payment. All patients will be provided with a signed receipt by the pharmacist for each prescription they are taking.

My employer is offering me the opportunity to receive my maintenance medications from the Express Scripts Canada Pharmacy. What information should I have on hand to register?

You will need to have the name of your insurer, carrier number, group or policy number, certificate or client identification number from your prescription benefit card. Also, please have your current maintenance medications on hand. If you call the Express Scripts Canada Member Contact Centre, you may be asked to provide contact information for your doctor, as well as for your current retail pharmacy. A valid credit-card number will also be needed at the time your order is placed.

How exactly do I enrol in home delivery?

You can enrol in the Express Scripts Canada Pharmacy by calling the Member Contact Centre toll-free at 1 (855) 550-MEDS (6337). The Member Contact Centre is open from Monday to Saturday – from 9 a.m. to 9 p.m. ET.

You can also enrol through conventional mail, using the Express Scripts Canada Pharmacy Enrolment Form. These forms can be requested from your Member Contact Centre.

How do I begin ordering prescriptions through home delivery?

If you plan to use home delivery to receive your maintenance prescription medications, you can transfer existing prescriptions from your current pharmacy or ask your doctor to write your prescription for a 90-day supply with up to three refills (if appropriate). Then, you can order prescriptions one of two ways:

Telephone. Call the Express Scripts Canada Pharmacy toll-free at 1 (855) 550-MEDS (6337). A Member Contact Centre advisor will get you set up for home delivery.
Mail. Complete an enrolment form (and mail it, along with your original prescription and payment information to:
Express Scripts Canada Pharmacy
PO Box 700
145 Queen Street South
Streetsville, Ontario L5M 2C2

The Express Scripts Canada Online Prescription Manager sounds really convenient. What else can I do from it?

You can use the Express Scripts Canada Online Prescription Manager to update profile information for yourself and your covered family members, update your billing and payment information, request additional prescription transfers and refill maintenance medications and pay for and track your prescription orders.

If I choose home delivery and would like to work with my doctor to do so, what steps do I need to follow?

If you would like to send your prescription to the Express Scripts Canada Pharmacy directly, you have two options:

Facsimile: You need to ask your doctor(s) to send a prescription for your maintenance medication(s), via facsimile, for up to a 90-day supply (plus refills for up to one year, if appropriate) to the Express Scripts Canada Pharmacy toll-free at 1 (888) 656-6505. Faxes must be sent from the office of the prescribing doctor. Faxes sent from your home or workplace will not be accepted.
Mail:
Express Scripts Canada Pharmacy
PO Box 700
145 Queen Street South
Streetsville, Ontario L5M 2C2

My doctor wants to charge me an extra fee to write a new prescription for the Express Scripts Canada Pharmacy. This is not convenient, nor was I anticipating this fee. What are my options?

In provinces such as Ontario, physicians are entitled to charge patients for uninsured services, which take physician time and resources, such as the transfer of medical records. To make it more economical and/or convenient for those patients who may use many uninsured services, physicians may offer patients a block fee, which may cover such costs.

This fee will not be covered by the Express Scripts Canada Pharmacy. If you do not want to pay a fee, you should make an appointment to see your doctor, and the appointment would be covered by your provincial health plan.

Which medications can I get from the Express Scripts Canada Pharmacy?

Maintenance medications you take regularly to treat ongoing medical conditions, such as asthma, depression, diabetes, high blood pressure and high cholesterol, can be filled and received through the Express Scripts Canada Pharmacy. For more information, refer to the Express Scripts Canada Pharmacy’s Maintenance Drug List. To find out whether a specific prescription medication is considered a maintenance medication under your benefit provider’s drug plan, call the Express Scripts Canada Pharmacy Member Contact Centre toll-free at 1(855) 550-MEDS (6337).

Are there types of medications I cannot receive through home delivery from the Express Scripts Canada Pharmacy?

Yes. The Express Scripts Canada Pharmacy will not offer home delivery service for the following medications:

Acute medications, those taken for short-term use
Narcotic and controlled substances

How will my prescriptions for existing maintenance medications be obtained by Express Scripts Canada from doctors and/or retail pharmacies?

Prescriptions can be received by the Express Scripts Canada Pharmacy in one of three ways:

Through standard mail from the member, including a written prescription from your doctor.
By fax from your doctor’s office, sent toll-free to 1 (888) 656-6505. (NOTE: Faxes sent from a member’s home or workplace will not be accepted due to pharmacy regulations.)
Through authorized transfer from a retail pharmacy.

How long will it take to process my order?

For standard first-time orders, you should allow seven to 10 days for delivery from the time the Express Scripts Canada Pharmacy receives your order. When mailing a first-time order, it is recommended that you have at least a 30-day supply of medication on hand. If the Express Scripts Canada Pharmacy needs to contact you or your prescribing doctor for information, delivery may take longer. For your first order, we also advise you to get two signed prescriptions from your doctor:

The first prescription is for an initial 30-day supply of medication to be filled at a participating retail pharmacy.
The second prescription is for up to a 90-day supply of medication with appropriate refills, which should be sent to the Express Scripts Canada Pharmacy.

You will be notified that your prescription has been received, when it has shipped and if there are any issues.

If Express Scripts needs to contact your doctor to obtain a new prescription for home delivery, you should allow two to three weeks to receive your order. If the doctor cannot be reached, you will be notified, either by telephone or by mail.

Once we have processed your first order, subsequent refills will be shipped within three to five days from the time the refill request is received.

Once prescriptions have been received by the Express Scripts Canada Pharmacy, what happens next?

The Express Scripts Canada Pharmacy will contact your prescribing doctor to obtain approval to optimize the use of lower cost generic drug equivalents as a substitute for expensive brand-name medications. In addition, if needed, further authorizations will be obtained to consolidate the filling and dispensing of the prescription to a 90-day supply, which will generate additional cost savings and convenience for you.

NOTE: At all times, your doctor will continue to be the one who ultimately decides which medication is appropriate and prescribed for you.

What interaction, if any, do I have with a pharmacist, after these changes to the prescriptions?

A follow-up counselling session with a licensed pharmacist is available to each patient. Each shipment of medication is accompanied by detailed printed instructions, including information about the drug, dosing directions, therapeutic benefits and potential side effects.

Do I need to complete a new home delivery order form each time I submit a prescription?

No. The order form is only necessary the first time you order a medication through the Express Scripts Canada Pharmacy, unless any of your information changes. All medications taken by you or your dependents should be listed so they can be reviewed for potential drug interactions. You can provide additional information on a separate sheet of paper, if necessary.

Can I submit more than one prescription at a time?

Yes. The Express Scripts Canada Pharmacy will process all of the prescriptions submitted, according to your benefit provider’s prescription drug plan.

Which methods of payment are accepted by the Express Scripts Canada Pharmacy for my portion of the cost of my medication?

You can pay for your medications through one of the following methods:

Credit card. The Express Scripts Canada Pharmacy will charge your portion (if applicable) to the Visa, MasterCard or American Express you provide at the time of enrolment. Express Scripts Canada Pharmacy will bill your employer for the remaining portion of the cost.

Online or telephone banking. You can pay for your medications through online or telephone banking at the following financial institutions (Express Scripts Canada Pharmacy as payee).
- BMO Financial Group (ING Direct)
- Canadian Western Bank
- CIBC
- Citizen’s Bank
- Credit Unions in Ontario (members of Central 1)
- RBC
- Scotiabank
- TD Canada Trust

Cheque (Ontario residents only). Cheques for your portion of the cost of the medication can be made payable to: “Express Scripts Pharmacy Ontario Ltd.” If remitting your cheque by mail, send it to: 
EXPRESS SCRIPTS PHARMACY ONTARIO LTD.
P.O. Box 9777, STATION A
Toronto, ON M5W 1R6
Attention: Accounts Receivable

Cheque (British Columbia and Alberta residents only). Cheques for your portion of the cost of the medication can be made payable to: “Express Scripts Pharmacy West Ltd.” If remitting your cheque by mail, send it to: 
EXPRESS SCRIPTS PHARMACY WEST LTD.
C/O V06490C, PO Box 6400, Station Terminal
Vancouver, BC V6B 6R3
Attention: Accounts Receivable

How do I refill my prescriptions?

Auto Refills is a standard feature of home delivery from the Express Scripts Canada Pharmacy that helps ensure you never risk running out of your maintenance medication. When you enrol in home delivery, the Express Scripts Canada Pharmacy will automatically refill your prescriptions and mail them directly to your home. You have peace of mind knowing you will always have your medication where you need it – when you need it.

You will be automatically enrolled in Auto Refills unless you choose not to be. To opt out of the Auto Refill program, contact a member advisor toll-free at 1(855) 550-MEDS (6337). Alternatively, you can also opt out, using the Express Scripts Canada Online Prescription Manager. Go to www.express-scripts.ca and follow the prompts.

Tell me exactly how Auto Refills works.

You can use Auto Refills for one, some, or all of your maintenance medications.
After you enrol in home delivery, the Express Scripts Canada Pharmacy calculates your prescription use and the days of supply that remain.
When it’s time to refill, we will automatically fill your prescriptions and mail them directly to your home.
To ensure that you never run out of your medications, the Express Scripts Canada Pharmacy will begin processing your refill order 18 days before our records show you will hit ZERO (0) days of supply remaining.
To keep you informed of your refill status, we will contact you seven (7) days before processing begins on your refill order.
You have the flexibility to cancel or reschedule an Auto Refill any time before the processing date.
For added confidence, we will contact you again once your order has shipped.

How long does it take when I refill my prescription?

Once the Express Scripts Canada Pharmacy has dispensed your first prescription, the Auto Refill program will let you know when it is time to get a new prescription and when your next order is ready to be shipped. If you choose to request your refills manually, those refills will be shipped to you within three to five business days from the time the refill request is received – depending on the method of shipping you select.

What should I do if my prescription changes?

If your prescription changes, notify the Express Scripts Canada Pharmacy by sending them a new prescription, or have your doctor fax it. The Express Scripts Canada Pharmacy will remove the old prescription from your file and process the new order.

How will my prescriptions be delivered to me?

Orders are sent by expedited parcel mail through Canada Post – at no extra charge – in unmarked, tamper-proof packaging. There is no indication on the package that it is from a pharmacy or that it contains prescription medication(s). In some provinces, such as Ontario, to comply with provincial regulations, your signature, or that of a named designate, will be required upon receipt of the package.

Is it possible to have prescription medications delivered overnight?

Yes. Overnight delivery may be requested with additional shipping and handling charges, although standard processing times still apply.

For more information on availability and rates, call the Express Scripts Canada Pharmacy Member Contact Centre toll-free at 1(855) 550-MEDS (6337).

When the package is delivered, what will be required of me or from whoever takes delivery of the package?

When someone answers the door, the delivery agent will hand off the item, and collect the signatory name and a signature. Children under the age of 18 cannot accept delivery of a package containing prescription medication.

What happens if there is no one at home?

If there is no answer at the door, the delivery agent will leave a Delivery Notice Card in the addressee’s mail receptacle. The Delivery Notice Card will direct the addressee to the nearest post office to pick up the package.

What exactly is a Delivery Notice Card?

A Delivery Notice Card is used to show that the item is available for pickup at a nearby post office. A Final Notice Card will be sent to the addressee if the item has not been picked up after five (5) calendar days. The item will be held at the post office for a total of 15 calendar days after which time it will be returned to the sender.

Who can pick up a package of prescription medication at the post office?

Only the addressee, or their Designated Agent, can pick up an item at the post office.

To sign for the package, the addressee, must present one valid piece of government-issued photo identification that indicates the same address to which the package was delivered.

A designated agent must present one valid piece of government-issued photo identification and one of the following documents to sign for a package of prescription medication:

A Delivery Notice Card signed by the addressee with the printed name of the individual authorized to pick up the item; or
A legal document that demonstrates the authority of the designated agent to act on behalf of the other individual, for example, power of attorney, appointment as trustee or a letter of authorization.

Some of my prescription medications require refrigeration. How will these be delivered?

The Express Scripts Canada Pharmacy will ship refrigerated items Monday through Wednesday, via Canada Post's Xpresspost service or via courier with Purolator.

What if I do not receive my order in a timely manner?

When you notify Express Scripts Canada of a delay, we will provide the shipping company with a tracking number to locate the parcel and provide a revised delivery date. If the package cannot be located and the order needs to be replaced, we will re-ship the medication free-of-charge to the member, using the type of delivery service that will ensure it arrives on time.

How do I know the Express Scripts Canada Pharmacy will fill my prescriptions correctly? Is home delivery as safe as using a retail pharmacy?

Licensed pharmacists check every prescription to make sure it is filled accurately and promptly. This includes reviewing for any possible drug interactions that are included within the order form you provide to us. The same level of care is exercised at shipping.

What if I receive the wrong medication?

The Express Scripts Canada Pharmacy takes dispensing errors very seriously, and will investigate reasons that contributed to any such mistake. In such a situation, a pharmacist will ask if you have ingested any of the medication. Once immediate risk is ruled out, we will correct the error, reverse the claim, and send you the proper medication free of charge. We will include a pre-paid envelope so you can send the incorrect medication back. Upon receipt, we will credit the amount previously charged for the incorrect medication.

Will I receive the same brand-name or generic prescriptions I am used to getting when I order from the Express Scripts Canada Pharmacy?

You and your doctors need to decide what’s best for you. Given your benefit provider’s prescription drug plan, generic equivalents may be dispensed when appropriate – and permitted by the prescribing doctor.

What is the difference between a chemically equivalent generic medication and a therapeutically equivalent generic medication?

A chemically equivalent generic is a generic medication that is made up of the same chemicals as a brand medication. For example, the brand-name medication Losec® and the generic medication omeprazole are chemically equivalent; the active ingredient in both products is omeprazole.

A therapeutically equivalent generic is a generic medication that is not made up of the same chemicals as a brand medication but provides the same effect. For example, the brand-name medication Nexium® and the generic medication omeprazole are not made of the same chemicals but are essentially identical in clinical effect.

What happens if my medication is on manufacturer back order?

The Express Scripts Canada Pharmacy will notify you by telephone if a manufacturer is experiencing supply difficulties and cannot furnish a date of availability. If your prescription was included with an order for other medications, we will process those not affected by the back order.

What if I have more questions?

You can contact the Express Scripts Canada Pharmacy Member Contact Centre (MCC) toll-free at 1 (855) 550-MEDS (6337). Your friendly member advisor will be happy to help you. The Member Contact Centre is open Monday through Saturday from 9 a.m. to 9 p.m. ET.