Pharmacy and Formulary Specifics
Drugs are available through Express Scripts large network of pharmacies.
The formulary represents the prescription therapies believed to be necessary in a quality treatment programs and was designed by Brand New Day in consultation with a team of healthcare providers.
Prescribed medications are covered by the Plan as long as the drug is medically necessary and all plan rules are followed. Refer to your Evidence of Coverage (EOC) for additional information on Part D Prescription Drug coverage or call Brand New Day Pharmacy Services.
Brand New Day may add or remove drugs from our formulary throughout the year. If we remove a drug from our formulary, add prior authorization for a drug, add quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must alert members taking that drug about those changes. If we’re removing a drug from our formulary, we’ll either notify affected members 60 days prior to making that change, or notify them when they request a refill of that drug (at which time the member will also receive a 60-day supply of that drug). If the Food and Drug Administration deems a drug on our formulary to be unsafe, or the drug’s manufacturer removes the drug from the market, we’ll immediately remove the drug from our formulary and provide notice to members taking that drug.
Contact Express Scripts (see contact information below) to discuss your options.
Or ask your doctor if there's an acceptable alternate medication covered under our formulary.
Express Scripts Contact
Express Scripts
Attn: Medicare Reviews
P.O. Box 66571
St. Louis, MO 63166-6571
Fax: (877) 251-5896
If you feel you were already charged incorrectly at the pharmacy, you can file an appeal to request reconsideration. If you would like to file an appeal, please call Express Scripts at 1-800-935-6103, available 24 hours a day, 7 days a week.
If we say no to your appeal, we will send a written notice telling you why we said no.
You then choose whether to accept this decision or continue by making another appeal.
The written notice tells you how to make another appeal. If you decide to make another appeal, it means your appeal is going on to Level 2 of the appeals process.
If you decide to go on to a Level 2 Appeal, the Independent Review Organization (C2C Innovative Solutions, Inc.) reviews the decision we made when we said no to your first appeal.
C2C decides whether the decision we made should be changed.
