What Express Scripts is and how it delivers medication
Express Scripts is a pharmacy benefit manager (PBM) that runs a mail-order pharmacy service. If your health insurance plan or employer uses Express Scripts, you can order maintenance medications — drugs you take regularly for chronic conditions — and have them shipped to your home instead of picking them up at a local pharmacy.
Express Scripts does not sell insurance. Instead, it sits between you, your insurance company or employer, and the pharmaceutical manufacturers. It processes your prescription claims, negotiates drug prices, and in the case of its mail-order service, fills and ships your prescriptions from centralized distribution centers.
Mail-order through Express Scripts typically costs less out-of-pocket than filling the same prescription at a retail pharmacy, because the company buys drugs in bulk and passes some savings to you. The tradeoff is that mail delivery takes longer than walking into a store — usually 7 to 14 days from the time you submit your order.
Key Takeaways
- Express Scripts is a pharmacy benefit manager that fills prescriptions by mail if your insurance plan or employer contracts with them.
- You order through their website, phone line, or mobile app, and medications arrive at your home in 7 to 14 days.
- Mail-order prescriptions usually have a lower copay than retail pharmacy fills, but you need to plan ahead because delivery is not when ready.
- Express Scripts maintains a formulary — a list of covered drugs — and some medications require prior approval from your doctor before they will fill it.
- If Express Scripts is not your plan's pharmacy benefit manager, you cannot use their mail-order service even if you want to.
How to order a prescription through Express Scripts
First, confirm that Express Scripts is your pharmacy benefit manager. Check your insurance card, your plan's website, or call the customer service number on your card. If Express Scripts is not listed, you will need to use a different mail-order pharmacy or a retail location.
Once you know Express Scripts handles your prescriptions, you have three ways to place an order. The fastest is through their website or mobile app — you can log in, search for your medication, and submit your order in minutes. You will need your prescription number from your doctor's office, or you can authorize Express Scripts to request it directly from your prescriber.
If you prefer to order by phone, call the number on your insurance card or the back of your Express Scripts member card. A representative will walk you through the process and answer questions about your copay or coverage. You can also mail a paper prescription directly to Express Scripts, though this method is slower and requires you to know their mailing address.
After you submit your order, Express Scripts will check whether the drug is on your plan's formulary and whether your doctor's prescription meets any coverage rules. If everything clears, they fill and ship your medication. If there is a problem — for example, your doctor prescribed a brand-name drug when a generic is required — Express Scripts will contact your doctor to resolve it before shipping.
Copays, refill timing, and how much you save
Your copay for a mail-order prescription depends on your specific insurance plan. Most plans charge less for mail-order than for retail — for example, a $15 copay at a drugstore might be $10 through Express Scripts for the same drug. Some plans offer even steeper discounts for 90-day supplies ordered by mail.
You can order a 30-day, 60-day, or 90-day supply, depending on your plan. A 90-day supply usually has the lowest per-dose cost and means you order less often, but it requires you to plan further ahead. If you are unsure which option your plan covers, check your plan documents or call Express Scripts customer service.
Express Scripts allows automatic refills — you can set up your prescription to refill and ship on a schedule, so you never run out. You can pause, resume, or cancel automatic refills anytime through the website or app. If you need your medication sooner than the scheduled refill date, you can request an early refill, though your plan may limit how often you can do this.
The actual savings depend on the drug, your plan, and whether a generic version is available. Brand-name drugs often have higher copays than generics, and some medications require you to try a generic or a cheaper alternative first before the plan will cover the brand name. This is called a step therapy requirement.
Prior authorization and formulary restrictions
Express Scripts maintains a formulary — a list of medications your plan covers and the conditions under which they are covered. Not every drug is on every formulary, and some drugs are covered only if you meet certain criteria.
If your doctor prescribes a medication that is not on the formulary, or that requires prior authorization, Express Scripts will contact your doctor before filling it. Prior authorization means your doctor must confirm to Express Scripts that the medication is medically necessary for you. This can add a few days to the process, but it is a coverage requirement, not something Express Scripts invented.
You can check whether a specific drug is on your formulary and whether it requires prior authorization by logging into your Express Scripts account or calling customer service. If a drug is not covered or requires authorization, ask your doctor whether a covered alternative exists. Sometimes switching to a different medication in the same drug class will get you coverage when ready.
What to do if your prescription is delayed or denied
If your order does not arrive within the expected timeframe, log into your account and check the status. Express Scripts shows tracking information once the package ships. If the tracking shows a delay, you can contact customer service to investigate.
If Express Scripts denies your prescription — meaning they will not fill it — they must tell you why. Common reasons include: the drug is not on your formulary, your doctor's prescription does not match the coverage rules, or you have already filled the maximum number of refills allowed in a given period. Express Scripts will explain the reason and often suggest a covered alternative.
If you disagree with a denial, you have the right to appeal. Contact Express Scripts customer service and ask for the appeals process. You will need to provide additional information from your doctor explaining why this specific drug is necessary for you. Appeals can take 2 to 3 weeks, so if you need the medication urgently, ask your doctor to write a prescription for a 30-day supply at a retail pharmacy while the appeal is pending.
Switching from retail to mail-order or between pharmacies
If you have been filling prescriptions at a retail pharmacy and want to switch to Express Scripts mail-order, you do not need permission — your insurance plan allows it. straightforward order through Express Scripts using your prescription number. Your retail pharmacy will not be notified, and you can continue using retail for other prescriptions if you choose.
If you want to switch away from Express Scripts to a different mail-order pharmacy or back to retail, check your plan documents to see whether other options are available. Some plans contract with only one mail-order provider, so you may not have a choice. If your plan does offer alternatives, you can switch anytime by ordering from the new pharmacy instead.
If you are in the middle of an automatic refill schedule with Express Scripts and want to stop, log into your account and cancel the refill, or call customer service. You will not be charged for future shipments once you cancel.
When Express Scripts mail-order is not the right choice
Mail-order works best for medications you take every day or several times a week — blood pressure drugs, diabetes medications, cholesterol drugs, and similar maintenance prescriptions. It is less practical for antibiotics, pain relievers you take occasionally, or any drug you need when ready.
If you need a medication urgently and cannot wait 7 to 14 days, use a retail pharmacy instead. Your insurance plan covers retail fills, and you will pay the retail copay. Once you have the urgent supply, you can order future refills through Express Scripts at the lower mail-order copay.
Some people prefer retail because they like talking to a pharmacist in person, or because they want to pick up a prescription the same day. That is a valid choice — your plan covers both retail and mail-order, and you can use whichever makes sense for each prescription.
Frequently Asked Questions
Can I use Express Scripts if my insurance does not list them as my pharmacy benefit manager?
No. Express Scripts only fills prescriptions for people whose insurance plan or employer contracts with them. If your plan uses a different pharmacy benefit manager, you will need to use that company's mail-order service or a retail pharmacy.
What happens if I move or my address changes?
Update your address in your Express Scripts account as soon as possible. If you have an order in progress, contact customer service to make sure it ships to your new address. Future refills will automatically use the updated address.
Can I order controlled substances like pain medication or stimulants through Express Scripts?
Some controlled substances can be ordered by mail, but rules vary by state and by drug. Contact Express Scripts or your doctor to confirm whether your specific medication can be mailed. Some controlled drugs require a new prescription each month and cannot be refilled automatically.
How do I know if my prescription was filled and shipped?
Log into your Express Scripts account and check the order status. Once the prescription ships, you will see tracking information. You can also set up text or email notifications so Express Scripts alerts you when your order is on the way.
What if I take my medication inconsistently and do not need a refill on schedule?
You can pause your automatic refill anytime through your account or by calling customer service. Resume it whenever you are ready. You can also request an early refill if you run out sooner than expected, though your plan may limit early refills to once per prescription per year.