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EmblemHealth Pharmacy Benefit Services (PBS)

Filling a Prescription

Retail Pharmacy

EmblemHealth members with prescription drug coverage have access to all major retail pharmacy chains, including Walgreens, Duane Reade, CVS, Rite Aid, Target and Walmart, as well as many independent pharmacies. In fact, our pharmacy network has over 60,000 locations nationwide, so you have easy access to a pharmacy near where you live or work. Simply present your EmblemHealth identification (ID) card at
any one of these pharmacies.

Maintenance Drugs

These drugs are commonly used to treat conditions that are considered chronic or long-term. These conditions usually need daily use of the drug. Some examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes. Drugs used to treat chronic conditions can be filled for up to a 90-day supply if so prescribed. Not all drugs that are used to treat chronic conditions are covered as maintenance drugs due to concerns for patient safety. Disposable insulin needles and syringes may be dispensed in the full box of 100, even if it represents a 100-day supply. All drugs are subject to member's rider benefit.

Some plans require maintenance drugs be filled through home delivery. Patients with these plans will first fill two 30-day supplies of the maintenance drugs before the patient can get up to the 90-day supply. This will help to determine the effectiveness of the selected drug. It also helps with cost savings.

Filling Your Prescriptions for Home Delivery

Express Scripts, Inc. (ESI), EmblemHealth's home delivery pharmacy, dispenses
long-term prescriptions (those with more than a 30-day supply) through the mail. These are also called "maintenance drugs." You may receive up to a 90-day supply of an approved medication through ESI. Delivery takes about two weeks.

For new prescriptions, you can visit www.StartHomeDelivery.com and complete the form. Or call EmblemHealth PBS at the number on the back of your ID card or ESI at
1-877-866-5798 to ask that a home delivery order form be mailed to you. Once you've filled it out, just mail as directed on the form. Your doctor may also fax your prescription to ESI and should call 1-800-305-5287 for instructions.

Home Delivery Refills

Ordering prescriptions refills is easy. You can order online, by phone or by mail:

• Online — Sign in and you will be able to see a list of your available prescription refills, as well as your prescription history. If other members of your household are covered under your prescription drug plan and they are 18 or older, they should register too. Select the items you want to reorder and follow the on-screen prompts to complete your request.
• Phone — Call ESI at 1-877-866-5798. You will need to have your prescription number handy when you call.
• Mail — Use the refill order form that comes with your mailed order. Mail it with your copay to ESI in the envelope provided.

Advantages of ESI Home Delivery

• Convenient delivery to your home
• Up to 90 days of medication provided at a time
• Refilling and checking the status of your prescriptions online
• Free standard shipping on every order
• Fewer trips to the local pharmacy
• You can talk to pharmacists, 24 hours a day, seven days a week

EmblemHealth Pharmacy Benefit Services Customer Service

If you have questions about your prescription drug benefits, please call EmblemHealth PBS:

• EmblemHealth CompreHealth and CompreHealth EPO members should call 1-877-842-3625, Monday through Friday, 8:30 am to 6 pm.
• InBalance EPO/PPO, Consumer direct EPO/PPO and EPO/PPO members should call 1-877-793-6253, Monday through Friday,
  8:30 to 6 pm.
• HIP members call 1-800-447-8255, Monday through Friday, 8 am to 6 pm.
• GHI members call 1-877-444-3786, Monday through Friday, 8:30 am to 6 pm.

Please note: The descriptions above contain general information about our plans and programs. Complete details, conditions, limitations and exclusions are contained in the member's contract or certificate of insurance.