Simply will administer pharmacy benefits for enrolled members. Express Scripts, Inc. (ESI) is the pharmacy benefits manager.
Please refer to the Preferred Drug List (PDL) when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.
Though most medications on the PDL are covered without precertification, a few agents will require you to contact our Pharmacy Department for authorization.
Precertifications by phone:
You can reach our Pharmacy Department at 1-877-577-9044 between 8:00 a.m. and 8:00 p.m. Eastern time Monday through Friday.
Precertifications by fax:
You can also fax your request to our Pharmacy Department:
Retail Prior Authorization - 1-877-577-9045
Medical Injectables - 1-844-509-9862
Please refer to the formularies when prescribing for Medicare members. Though most medications on the formulary are covered without precertification, a few agents will require you to obtain an authorization. For Medicare Part B, contact Provider Services department 1-866-805-4589 Option 5, from 8:00 a.m. to 8:00 p.m. local time, Monday through Friday. For Medicare Part D, contact Express Scripts Provider Services at 1-800-338-6180 24 hours a day, 7 days a week.
Providers can send a request for a prescription coverage determination or an appeal for a Medicare plan via email rather than fax or phone by sending the request to the following address:
Express Scripts, Inc. is a separate company that provides pharmacy services and pharmacy benefit management services on behalf of health plan members.