MEDICARE/PRESCRIPTION INFORMATION

Through Express Scripts’ continued discussions with CMS, CMS clarified the intent of the Member Consent guidance was aimed at addressing concerns related to members who do not already have experience using a home delivery pharmacy, and may not be familiar with e-prescribing, auto-refills, or other processes related to using home delivery. CMS therefore formally confirmed in a March 21, 2014 guidance update, that Express Scripts does not need to obtain member consent on New or Renewal scripts that are not received directly from the member, as long as the member has used Home Delivery within the past 12 months. Thus, the policy of obtaining member consent prior to mail order delivery, now only applies to members that have not used mail order/home delivery within the past 12 months, if their Rx was not initiated directly by the member. ESI implemented this change on March 27, 2014.

Member Consent Policy – What this means-

·        ESI reverts back to the original Member Consent Policy, but it now only applies to members that have not used Home Delivery within the past 12 months;

o   ESI will obtain consent to ship New Rx (includes Renewal Rx) via AOM (automated outbound message) followed by the attached letter after 3 failed AOM attempts.  Again, this only applies to members that have not used Home Delivery in the past 12 months, if/when the script was not received directly from the member.

o   ESI will pend an order for a non-controlled substance for 1 year while waiting for consent & a controlled substance for 6 months while waiting for consent

·        Member Refund Policy -- Same refund policy exists on any auto-shipped scripts, regardless of whether we obtained consent or not

The consent letter is attached.