Plan Sponsor Frequently Asked Questions

The following questions pertain to Express Scripts Canada’s pharmacy benefit management (PBM) service and home delivery of maintenance medications from the Express Scripts Canada Pharmacy – and the benefits it will have for companies and organizations who provide health-care benefits to their employees:

What is Express Scripts Canada’s pharmacy benefit management service and home delivery from the Express Scripts Pharmacy?

Express Scripts Canada’s pharmacy benefit management (PBM) service, which can be easily added by companies and organizations without changing insurance carriers, leverages research and proven best practices in behavioral sciences to actively engage members of health benefits plans to more effectively manage benefit costs and their health.

Express Scripts Canada’s PBM service includes the Express Scripts Canada Pharmacy, which dispenses up to 90-day supplies of maintenance prescription medications to treat chronic medical conditions, such as asthma, diabetes, high cholesterol and high blood pressure. These prescriptions are subsequently delivered, via free standard shipping, to a plan member’s home or designated address.

After registering plan members will be able to use the Express Scripts Canada Online Prescription Manager to order, pay for and track subsequent refills of their maintenance medications, after the initial fulfillment of their prescription. Prescription refills can be ordered by telephone, or over the Internet through the Online Prescription Manager.

A highly skilled team of pharmacists and pharmacy technicians verify the clinical quality of each and every prescription dispensed and distributed from an Express Scripts Canada Pharmacy. The Express Scripts Canada Pharmacy provides patients with access to pharmacists to answer questions about their medications.

Plan members will interact with a team of highly qualified professionals about their maintenance medication alternatives so that they can make informed choices with the support of their physician. The result will be informed decisions that offer the best possible health outcome while reducing costs for both the member and their plan sponsor.

The Express Scripts Canada Pharmacy offers two program options, Select Home Delivery or Exclusive Home Delivery. 

What is Select Home Delivery?

Select Home Delivery is a unique, choice-based solution that encourages members to fill their maintenance medications using the Express Scripts Canada Pharmacy.  It provides members with a convenient and affordable way of obtaining maintenance medications, while preserving individual choice and member satisfaction.

Is enrolment in Select Home Delivery mandatory?

No. Members can choose to use home delivery from Express Scripts Canada Pharmacy or to use retail.  With Select Home Delivery, the member must notify Express Scripts Canada of their choice.

What is Exclusive Home Delivery?

Exclusive Home Delivery provides members with a convenient and affordable way of obtaining maintenance medications. They can receive up to three fills or up to a 90-day supply of certain maintenance medications at a retail pharmacy. They then have the choice to continue filling at a retail pharmacy and paying 100% of the cost of the medication without reimbursement, or to use home delivery from the Express Scripts Canada Pharmacy.

What are the advantages of using the Express Scripts Canada PBM and Express Scripts Canada Pharmacy for maintenance medications?

Convenience & Satisfaction

• Getting started is easy –members can sign up online, by phone or by mail.
• Members receive up to a 90-day supply with free standard shipping. Refills are automatic in the future, unless they decide not to refill the prescription.

Lower Costs

• Members can save money by ordering up to a 90-day supply of maintenance medications.
• Pharmacists review for lower cost alternatives, educate members about their savings opportunities and offer concierge service to move to the lower-cost alternatives with the agreement of the prescribing doctor.

Safety and Therapy Adherence

• Registered pharmacists check every prescription and are available to provide counseling to the patient.
• Automatic refills and refill reminders help the patient have a continuous supply of medication available.

Can companies and organizations whose prescription claims are not adjudicated by Express Scripts Canada use PBM and home delivery services?

Yes. It is not necessary for Express Scripts Canada to be your adjudication provider to take advantage of the services being offered through the PBM and the Express Scripts Canada Pharmacy.

A company reaches an agreement with Express Scripts Canada to administer its benefits. What happens then?

Plan sponsors contact their employees to inform them that they have entered into an agreement with Express Scripts Canada to provide services to enhance the management of their prescription drug benefits. They are informed that Express Scripts Canada will contact them to begin the enrolment process, based on their chosen method of communication – choices are by telephone, postal mail or by EMAIL. Employees can then enrol by telephone or by mail.

How will prescriptions for existing maintenance medications be obtained by the Express Scripts Canada Pharmacy on behalf of plan members?

Members will be able to submit their prescriptions to the Express Scripts Canada Pharmacy in two different ways.  First, they can request prescriptions be obtained on their behalf by the Express Scripts Canada Pharmacy.  This can be done by logging on to the Express Scripts Canada Online Prescription Manager or by calling the Express Scripts Canada Pharmacy Member Contact Centre.  The Express Scripts Canada Pharmacy will then request a prescription transfer from the current retail pharmacy or request a new prescription from their physician.  Or, members can mail their prescriptions directly to the Express Scripts Canada Pharmacy.  Members will be contacted once their prescription has been received and again once it has shipped. 

Once prescriptions have been received, what happens next?

Once prescriptions have been received, they will be filled and verified by registered pharmacists.  As part of this process, lower-cost alternatives may be identified, which can result in additional cost savings for the plan sponsor and the member.  If lower-cost alternatives are identified, with the agreement of the patient and the prescribing doctor, the Express Scripts Canada Pharmacy will help the member take advantage of this opportunity.

How do companies and organizations find out more about supplementing their existing prescription drug coverage with Express Scripts Canada PBM service and Express Scripts Canada Pharmacy?

Interested companies and organizations can receive more information about Express Scripts Canada’s PBM service by sending an email, with their contact information, to PBMInformation@express-scripts.ca. An Express Scripts Canada representative will be in touch shortly thereafter.