Frequently Asked Questions
Here are some of the frequently asked questions Scrip World
receives a useful tool for explaining prescription drug concepts to members.
About Scrip World
Preferred Drug List
- How can I tell if my prescription medication is covered under my prescription plan?
- Who decides which drugs are covered under my plan?
- Why is a drug not covered by my plan?
- What is the Preferred Drug List?
- How does Scrip World decide what medications are on the Preferred Drug List?
- How can I find the most up-to-date Preferred Drug List?
- Does my physician need a copy of the Preferred Drug List?
Generic Drugs
- What are the similarities between brand name and generic drugs?
- What is the difference between a brand name drug and a generic drug?
- Do generics help save me money?
- Why should I request my physician to substitute a generic drug for a brand name drug?
- Are generics widely available?
Mail Order Service
- What are the advantages of using mail order service?
- How do I use the mail order service?
- How does my doctor need to write my mail order prescription?
- How can I obtain a Mail Service Enrollment Form?
- Does my prescription expire?
- Do I need to submit an order form when I refill mail order prescriptions online?
- Can I use a credit card to pay for mail order prescriptions online?
- Can I use a check or money order to pay for mail order prescriptions or prescription refills?
- How long will it take for mail order prescriptions to reach me?
- How can I check the status of a mail order?
Retail Pharmacy Purchases
- When should I use a retail pharmacy rather than mail order?
- How can I find a conveniently located retail network pharmacy?
- Can I use an out-of-network pharmacy?
- Do I need my ID card when purchasing prescriptions at a retail pharmacy?
- If I pay cash for a prescription at an out-of-network retail pharmacy, how can I obtain reimbursement?
ID Card
- If I lose my ID card, how can I obtain a new one?
- What if I don't have my lD card with me when I pick up a prescription at a network pharmacy?
About Scrip World
Who is Scrip World?
Scrip World is a pharmacy benefit manager who provides prescription drug benefits to more than 140,000 members. [back to top]
What does Scrip World do?
Members with Scrip World benefits fill their prescriptions at participating retail pharmacies or through the mail service (if offered through your plan). Each time a prescription is filled, the Scrip World computer system checks the patient's eligibility for pharmacy benefits, looks for possible drug interactions and returns the correct co-payment based upon the plan benefits. [back to top]
Preferred Drug List
How can I tell if my prescription medication is covered under my prescription plan?
Under the Scrip World prescription drug plan, you and your physician are free to choose any prescription drug; however, you will obtain the greatest cost savings when you select drugs included in the Preferred Drug List. [back to top]
Who decides which drugs are covered under my plan?
Your plan sponsor or employer determines which prescription drugs are covered. Scrip World does not decide this for your plan. We suggest coverage based upon the recommendations of the Pharmacy & Therapeutics (P&T) Committee comprised of doctors and pharmacists. We follow your plan sponsor's or employer's guidelines and process your prescription claims according to the benefit structure. [back to top]
Why is a drug not covered by my plan?
To help control costs, some types of medications may not be covered by your prescription drug benefit. These include medications used for cosmetic purposes such as wrinkles, baldness, or weight loss. If you choose to take these medications, you will be responsible for the cost of the medication. [back to top]
What is the Preferred Drug List?
On a national basis, prescription drug costs have risen steeply in recent years. To minimize your share of these costs and provide you and your physician with an extensive range of clinically effective drug choices at affordable co-pays, your prescription plan includes the Preferred Drug List.
The Preferred Drug List classifies prescription drugs into three categories, or tiers.
- Tier 1 consists of generic drugs. Generic drugs can be purchased for the lowest co-pay.
- Tier 2 includes preferred brand-name drugs for which generic equivalents are not available. Tier 2 drugs can be purchased for moderate co-pays.
- Tier 3 drugs have the highest co-pay. These are non-preferred brand-name drugs for which generic equivalents may or may not be available.
How does Scrip World decide what medications are on the Preferred Drug List?
A committee of qualified, practicing pharmacists and physicians is responsible for developing, maintaining and improving the Preferred Drug List. This committee meets regularly to discuss new drugs and trends in drug therapy. They meticulously review the list and modify it when appropriate to reflect current conditions. Updates generally are issued on a quarterly basis.
The committee considers the following criteria in creating, reviewing, and revising the Preferred Drug List:
- Safety. The drug must demonstrate unequivocal safety for therapeutic use.
- Effectiveness and medical necessity. The drug must be effective and medically necessary for the treatment, maintenance or prevention of medical conditions.
- Acceptance. The drug must be accepted for use by the general medical community.
- Cost Effectiveness. The drug must be cost effective for the treatment of medical conditions.
- Superior Outcomes. The drug must demonstrate therapeutic outcomes that are superior to similar, less costly alternatives.
How can I find the most up-to-date Preferred Drug List?
You will find an up-to-date Preferred Drug List on the Scrip World web site. Choose Participants on the main menu, then click Formulary and Forms to access the list. You can view the list online or print out hard copies. [back to top]
Does my physician need a copy of the Preferred Drug List?
It will be helpful to your physicians if you provide them with copies of the Preferred Drug List to keep in your medical file or bring the list when you or a family member visits a physician. When discussing prescription drug therapy with your physician, ask him or her to consider medicines included on the list and, whenever possible, prescribe generic or preferred drugs. [back to top]
Generic Drugs
What are the similarities between brand name and generic drugs?
Generic and brand name drugs are similar in several ways:
- They are equally effective in treating the medical conditions for which they are prescribed.
- They are tested, approved and regulated by the FDA in the same manner as brand name drugs.
- They contain equal amounts of the same active ingredients in the same dosage.
What is the difference between a brand name drug and a generic drug?
There are two major differences between brand name drugs and generic drugs: cost and appearance.
Cost. Generic drugs cost less than brand name drugs. This is because manufacturers of new drugs spend significant amounts of money in research and development before they bring the drugs to market and begin to see revenues. To help manufacturers recover these costs, the government grants patent protection to new drugs for a number of years following the introduction of the drugs to the market. During this time, an original drug manufacturer has the exclusive right to produce and market the drug under a brand name.
When the patent expires, other companies can produce generic equivalents. These companies spend a small fraction of the cost of originally developing the drug. For this reason, they can produce the generic drug for a lower cost and sell it for a lower price.
Appearance. Generic drugs look different from their brand name counterparts because they have different inactive ingredients. Inactive ingredients, such as dyes and fillers, determine a drug's size, shape and color but do not affect the way in which the active ingredients work. [back to top]
Do generics help save me money?
Because all generic drugs are available at the lowest co-pay, generic drugs can save you significant amounts of money. [back to top]
Why should I request my physician to substitute a generic drug for a brand name drug?
Because generics are available at the lowest cost, the use of generics can save you significant amounts of money. This is why it is important to share the Preferred Drug List with your physicians and request that they prescribe generics whenever possible. [back to top]
Are generics widely available?
Nearly half of all drugs have generic equivalents, and all 50 states have laws allowing pharmacists-with the doctor's approval-to dispense generic drugs for prescriptions written for the brand-name drug. [back to top]
Mail Order Service
What are the advantages of using mail order service?
Mail order service is convenient and economical. The mail order program allows you to order up to 90-days supply of your prescriptions (with physician approval) and have the medications delivered to your door. [back to top]
How do I use the mail order service?
For your first order, you will need to complete the Mail Service Enrollment Form for yourself and any family members. Mail the form and the original prescription to the mail order facility. After your first fill, you may call customer service at the number on your ID card or go online for refills. [back to top]
How does my doctor need to write my mail order prescription?
Your doctor needs to write your prescription for up to a 90-day supply of medication with each fill. Your doctor should also allow for three refills, if appropriate. [back to top]
How can I obtain a Mail Service Enrollment Form?
You may a mail order form from your HR Manager or call customer service at the phone number on your ID card. [back to top]
Does my prescription expire?
The majority of prescriptions expire one year from the date they are written. After the expiration date, the prescription cannot be filled even if you have refills remaining.
A prescription for a controlled substance expires within six months from the date it was written. [back to top]
Do I need to submit an order form when I refill mail order prescriptions online?
No, if you used mail order service to fill your original prescription, you do not need to submit an order form for online prescription refills. To order a refill, click Participants on the main navigation bar, then click Mail Order Services and follow the instructions for refilling your prescriptions. [back to top]
Can I use a credit card to pay for mail order prescriptions online?
Yes, you can use a credit card to pay for mail order prescriptions online. The use of a credit card is convenient and secure. [back to top]
Can I use a check or money order to pay for mail order prescriptions or prescription refills?
Yes, you can pay for mail order prescriptions with checks or money orders. First, determine the cost of the prescription online, then complete a mail order form and send it to the address on the form along with your check or money order in the proper amount. It is not a good practice to send cash to pay for mail order prescriptions as cash can easily be stolen. [back to top]
How long will it take for mail order prescriptions to reach me?
The first time you place a prescription mail order, the prescription typically is processed within 48 hours of its receipt and mailed within 14 business days. For refills of prescription mail orders, the prescriptions typically are processed and mailed within 2 or 3 business days. [back to top]
How can I check the status of a mail order?
To check the status of your mail order, click Participants on the main navigation bar, then click Mail Order Services and follow the instructions. You will need to input the member's ID number, the patient's date of birth and the prescription number (RX#), so keep this information handy. [back to top]
Retail Pharmacy Purchases
When should I use a retail pharmacy rather than mail order?
You should use a retail pharmacy in two instances: (1) when your prescription is written for 30 days or less and (2) when you need to obtain the first 30-day supply of a prescription for a chronic condition requiring long-term drug therapy.
Prescriptions written for 30 days or less. When you need to fill a prescription for 30 days or less, you should take the prescription to your network pharmacy and present your ID card. When the prescription is ready, simply pay the appropriate co-payment and you're on your way.
Note: Today, many pharmacies keep your information on their computer systems. At these pharmacies, you only need to present your ID card the first time you have a prescription filled.
Prescriptions for the first 30-days of long-term drug therapy. If you have a chronic condition that requires long-term drug therapy, such as diabetes, asthma, high blood pressure, ulcers or high cholesterol, you may obtain supplies for up to 90 days with your physician's approval. Ask your physician to write two prescriptions: one for 30 days and the second for 90 days. Take the 30-day prescription to your participating pharmacy to obtain an initial supply. Submit the 90-day prescription to Scrip World through the mail or online. [back to top]
How can I find a conveniently located retail network pharmacy?
Thanks to the expansiveness of the Scrip World pharmacy network, finding a conveniently located network pharmacy is simple. Click on the Participants button on the main navigational bar, then click on Find a Network Pharmacy. You will be guided through the process of identifying pharmacy names, phone numbers and addresses. You can even obtain directions and a map! [back to top]
Can I use an out-of-network pharmacy?
Yes, you can use an out-of-network pharmacy. However, you will have to pay the entire cost of the prescription at the point of purchase, then file a claim for reimbursement.
Because the Scrip World pharmacy network is expansive, it is likely that there is a network pharmacy conveniently located near your home or work. To locate the closest network pharmacy, click on the Participants button on the main navigational bar, then click on Find a Network Pharmacy. You will be guided through the process of identifying pharmacy names, phone numbers and addresses. [back to top]
Do I need my ID card when purchasing prescriptions at a retail pharmacy?
Today, many pharmacies keep your information on their computer systems. At these pharmacies, you only need to present your ID card the first time you have a prescription filled. However, it is important to always carry your ID card so you have it in the case of an emergency, when you are away from home, or for any occasion when it is not convenient to use your regular pharmacy. [back to top]
If I pay cash for a prescription at an out-of-network retail pharmacy, how can I obtain reimbursement?
If you pay cash for a prescription, be sure to save your receipt. Complete a Prescription Drug Claim Form and send it, along with your original receipt, to Scrip World at the address on the form.
Note: You must submit your original receipt to obtain reimbursement. Keep a copy of the receipt for your records.
To obtain the reimbursement form, click Participants on the main navigation bar, then click Download Forms on the drop-down menu. You will see a list of available forms. Select Prescription Drug Form to download and print the form.
You may also request the form from your HR Manager or call customer service at the phone number on your ID card.
Note: Submission of a claim for reimbursement does not guarantee that you will be reimbursed for the full amount you paid. You will be reimbursed for the amount on your receipt minus your co-pay and any other applicable amounts. [back to top]
ID Card
If I lose my ID card, how can I obtain a new one?
If you lose your ID card, call Scrip World at (800) 830-2310. [back to top]
What if I don't have my lD card with me when I pick up a prescription at a network pharmacy?
If it is the first time you have filled a prescription at the network pharmacy, you may need to pay cash and take one of the following steps to obtain reimbursement:
You may submit a claim for reimbursement (see instructions to under foregoing question) or you may return to the pharmacy with your ID card within 10 days of the purchase and have the pharmacy re-process the prescription. The pharmacy will reimburse you the difference between your co-pay and any other applicable amounts and the cost of the prescription. If you complete this process, you do not need to submit a form. To avoid these inconveniences, always carry your ID card with you. [back to top]
