Xyplorer Scripts Express Members

From the busy mom ordering her child’s prescriptions on her phone, to the retiree managing diabetes with help from our specialist pharmacists – every day, we work to improve and simplify care for our members – so they can get on with living their lives.

Express Scripts Part D Pharmacy Network. Express Scripts Medicare has a broad network of pharmacies nationwide, including preferred retail pharmacies such as CVS Pharmacy ®, Kroger, Walgreens and Walmart.We also offer preferred home delivery right to your mailbox from Express Scripts Pharmacy ® for added safety and convenience at no additional cost. XYplorer Scripting, introduced with version 7.00, can truly be seen as the ultimate in file management efficiency. Roll your own custom commands, combine them to scripts, wrap them in an XY Script file (XYS), or a User-Defined Command, and trigger them by just a click or a keystroke.Can't get any better? DS Logon is a secure, self-service logon credential that allows those affiliated with DOD or VA to access multiple websites using a single username and password. Before using those credentials to access Express Scripts, you must have activated your online account at express-scripts.com. Express Scripts Pharmacy® will process your prescription and mail it to you. If a copayment applies, you’ll receive an invoice in the mail. Your doctor can submit prescriptions directly to us through the electronic medical record (EMR) at: Express Scripts Home Delivery Pharmacy, 4600 North Hanley Road, St. Louis, MO 63134.

Medication only works when taken properly. So along with uncomplicated access to affordable medicine and compassionate care, we offer advanced programs and digital tools that enable our members to take control of their health.

life-changing and life-saving interventions through our Advanced Opioid Management^® program.

average savings by members on 90-day prescriptions through home delivery vs. 30-day at retail.

members receive expert service and compassionate care – 24/7/365.

I’m deeply grateful for your assistance with my medication, which is helping me in my need.

Medicare Part D Formulary (drug list)

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A formulary is the list of drugs covered by a Part D plan. Medicare requires all Part D plans to cover at least two drugs in each therapeutic drug category.

Express Scripts Medicare plans typically cover the drugs listed in the formulary, as long as:

The drug is medically necessary
The prescription is filled at one of our network pharmacies
Any special drug coverage rules are followed, as required

Some types of drugs are not covered by Medicare Part D, such as drugs for weight loss or cosmetic purposes.

The level of coverage for each drug will depend in part on which tier the drug is in. You can find more information about drug tiers in the Evidence of Coverage and formularies listed below.

Tier 1 Preferred Generic Drugs
Tier 2 Generic Drugs
Tier 3 Preferred Brand Drugs
Tier 4 Nonpreferred Drugs
Tier 5 Specialty Tier Drugs
Tier 6 Select Care Tier Drugs (Value and Choice plans only)

NEW! Part D Seniors Savings Model

Express Scripts Medicare offers insulin at an affordable and predictable price with our Saver and Choice plans. You will pay $35 or less for select insulin medications from any network pharmacy, in all stages up to the Catastrophic Coverage Stage. View a list of the included drugs. If you receive 'Extra Help,' you do not qualify for this program, and your Low-Income Subsidy copay level will apply.

To view and/or print our formulary now, click on the plan option below:

You may also access our online searchable tool to confirm if your drugs are covered and to see if there are any special coverage rules.

To request a comprehensive formulary be mailed to you, send an email with your full name, phone number and mailing address to documents@express-scripts.com. For assistance, call 1.866.477.5703, 8 a.m. to 8 p.m., 7 days a week, except Thanksgiving and Christmas. TTY users, call 1.800.716.3231.

Special drug coverage rules

Some drugs have special coverage rules that may:

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Limit the amount of a particular drug you can get
Require that you get prior approval from the plan before a drug is covered (known as prior authorization)
Require that you first try a certain drug to treat your condition before another drug is covered (known as step therapy)
Limit which pharmacies you can use

Drugs that are subject to these rules are clearly marked in the formulary.

View the list of prescription drugs that currently have prior authorization or step therapy requirements and the rules that apply to each drug:

Saver plan

Value plan

Choice plan

Once coverage begins, you may request an exception to our coverage rules. Learn more about exceptions and appeals.

Formulary changes

Express Scripts Medicare plans may periodically:

Add a drug to or remove a drug from the Drug List
Move a drug to a higher or lower cost-sharing tier
Add or remove a restriction on coverage for a drug
Replace a brand-name drug with a generic drug

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If we make certain changes to our formulary for a drug you are taking, we will either notify you at least 30 days before the change is made or notify you after the change is made and give you a 30-day refill of the drug at a network pharmacy.

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If the U.S. Food and Drug Administration finds that a drug on the formulary is unsafe, or if the drug's manufacturer removes the drug from the market under Medicare Part D regulations, we immediately remove the drug from our formulary and then notify you of the change.

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For additional information on formulary changes, please review Chapter 3 of the Evidence of Coverage.