The amount of medicine you use during a 1-month period. In most cases, your doctor will prescribe a 1-month supply or less for short-term medicine.
The amount of long-term medicine you use during a 3-month period. In most cases, prescriptions for long-term medicine are written for a 3-month supply. The actual quantity or days' supply you receive depends on your plan’s rules.
A term used to refer to the services covered by your health insurance. Express Scripts manages your “pharmacy benefit” for your employer, your health plan, or your plan sponsor.
Medicine that is sold by a company under a specific name or trademark and is protected by a patent.
A paid or unpaid person who helps with any needs required by someone who can’t meet his/her own needs. This covers a broad spectrum of needs, ranging from daily living tasks (eating, bathing, dressing) to helping with tasks on an as-needed basis (such as running errands). If you want a caregiver to be able to manage your medicines and your Express Scripts online account, you must make him or her a “designated caregiver” using the Add a Caregiver page in the Accounts menu. If you are a caregiver and hold a person’s power of attorney (POA), your client still must designate you as a caregiver using the Add a Caregiver page in the Accounts menu.
A request for payment submitted to your health insurance by you or by your healthcare provider. This request is for any services you think might be covered by your plan.
The partial cost you pay for your medicine, each time you fill a prescription. The amount you pay is set by your plan and is a percentage of the total cost.
- The price of your medicine is $100.
- Your coinsurance is 20%.
- You pay $20 for the medicine.
Your coinsurance is different from your copayment, or copay.
Medicine with different ingredients combined together in order to tailor it for individual needs. Once mixed together, compound drugs are not FDA-approved.
The number we apply to every order that you place. This number helps us find your order in our system if you need to ask us about your order.
A term used only for medicines or illegal drugs that have a high risk for causing harm. It means the medicine requires a doctor’s prescription and that its use is restricted by law (the Controlled Substances Act). The term covers medicines, such as opioid drugs. It does not apply to tobacco or alcohol.
Coordination of benefits (COB)
If you are covered by two or more health plans, this process decides the amount each plan pays for a claim.
A set dollar amount you pay out of your own pocket for your medicine. Your copay is set by your plan.
Your copay is different from your coinsurance.
If you take a medicine to treat a long-term condition (one that lasts 3 months or longer), then your prescription plan might use certain rules that affect the price of your medicine and the way you get it. A “courtesy fill” is the number of fills and refills you can order, before these rules fully take effect.
These rules include factors such as the medicine type, form, amount you get, what pharmacy or pharmacy network you use, and others. After you’ve used your “courtesy fills” limit, you’ll need to follow your plan’s rules for getting your medicine in order to avoid paying a higher price for it.
See Prior Authorization (PA).
The number of days’ worth of medicine your doctor prescribes for you. There are limits for the maximum number of days, based on the type of medicine, why you’re taking it, and your prescription plan’s rules.
- If your plan includes delivery of long-term medicines, your doctor will prescribe the maximum days’ supply allowed by your plan.
- If your plan includes the option to fill certain long-term medicine through local network pharmacies, you can check coverage and pricing using our Price a Medication tool, and we’ll set your days’ supply to the maximum allowed by your plan.
The total amount you must pay before your plan starts paying for part of your prescription costs. This amount varies by plan.
This is a process doctors can use to send a prescription to a pharmacy using a secure computer network.
Extended payment program (EPP)
This lets you pay for your delivery prescriptions in three monthly payments (installments), instead of paying the full amount all at once. Each monthly payment is automatically processed using your preferred payment method.
Example: you order a prescription that costs $90 and your preferred payment method is a credit card. Under the EPP, you would make 3 monthly payments as follows:
- First payment: As soon as your prescription ships, we’ll charge your card $30.
- Second payment: 30 days after your prescription ships, we’ll charge your card another $30.
- Third payment: 60 days after your prescription ships, we’ll charge your card the final payment of $30.
Flexible Spending Account (FSA)
An account set up through your employer that you can use to pay for certain out-of-pocket medical costs with tax-free dollars. You decide how much money to put in your FSA, up to a limit set by your employer. Your employer also can put money in the account. You don't pay taxes on this money. You can use your FSA to pay for healthcare costs, such as insurance copays and deductibles.
A prescription or over-the-counter (OTC) medicine that has the same active ingredient as a brand-name version that’s on the market. Generic drugs often are a lower-cost option to their brand-name versions. They can be identical to the brand-name drug or a:
- generic equivalent: it’s similar to the brand-name drug and has the same active ingredient, but has different inactive ingredients.
- generic alternative: it has a different active ingredient from the brand-name drug, but a similar clinical effect on the body.
You can find out more about generic drugs from the US Food and Drug Administration.
A contract that requires your health plan to pay some or all of your healthcare costs in exchange for a fee (this is called a “premium”). Your health insurance is divided into two parts:
- services — this includes things such as doctor appointments, hospital visits, and some medical supplies.
- prescription medicines — this includes your medicine and supplies related to your prescription. Your prescription plan from Express Scripts (also called a “pharmacy benefit”) is the part that covers your prescription medicines and supplies.
Health Savings Account (HSA)
A savings account you can set up if you have a high-deductible health plan. An HSA lets you set aside pre-tax money to pay for certain medical costs, such as deductibles, copayments, and coinsurance. You can roll over your unused balance into the next year and change how much you contribute to the account at any point during the year.
Healthcare Reimbursement Account (HRA)
An account offered by employers that provides tax-free reimbursement for qualified medical costs up to a fixed dollar amount each year. In many HRA plans, you can roll over your unused amounts from the current year to use in the next year. You might also hear HRAs called Health (or Healthcare) Reimbursement Arrangements.
The number we place on your package when we ship medicine to you. If your order ships in more than one package, then you will have more than one invoice number.
A person with special training about medicines, and licensed to practice by a national and state board. Express Scripts pharmacists are licensed and many have extra training to give advice about medicines to treat:
- Heart disease
- High blood pressure
- High cholesterol
- Migraine headaches
- Women's health conditions
Any medicine you have to take for three or more months to control symptoms or to prevent complications from a condition. Examples of conditions that might require long-term medicine include: high blood pressure, high cholesterol, diabetes, arthritis, heart conditions, and long-term pain.
Another term for “long-term medicine.”
National Drug Code (NDC)
A unique number the US government assigns to every prescription and over-the-counter (OTC) medicine on the market. The code refers to the strength and dosage form (such as liquid, tablet, capsule, etc.) and to those who make or distribute it. This number is required on the Express Script Prescription Drug Reimbursement / Coordination of Benefits Claim Form.
National Preferred Formulary (NPF)
A formulary is a list of the medicines covered by your health plan. The Express Scripts National Preferred Formulary is the list of medicines we recommend to treat various conditions. Some plans use our NPF, while other plans modify the list of medicines they cover.
Express Scripts revises its NPF every year, based on reviews of research about the medical value of medicines and their costs. The process of reviewing the NPF and making yearly updates is designed to give members access to the most effective medicines at the lowest possible prices. Your doctor always makes the final decision about the best medicine for you.
The amount of medicine you use during a one-month period. In most cases, your doctor will prescribe a one-month supply or less for short-term medicine.
Open enrollment or open-enrollment period
The period of time during which you can enroll in a health insurance plan. This period is set by your plan. You can change your health plan coverage during certain life events, such as getting married, having a baby, or losing other health coverage. These are sometimes called "qualifying events."
The money you pay out of your own pocket for your medicine before your plan covers the rest of the cost.
Pharmacy benefit manager (PBM)
An organization that manages the pharmacy portion of health plan coverage to make sure the use of medicine is safer and more affordable. Express Scripts is a PBM and a member of the national association of PBMs, the Pharmaceutical Care Management Association.
A group of pharmacies that work together to help keep the cost of your medicine as low as possible. In most cases, you’ll pay less for medicine from an in-network pharmacy than from a pharmacy outside of your network.
A 2-month period of coverage under a group health plan. This 12-month period might not be the same as the calendar year.
A 12-month period of coverage under an individual policy. This 12-month period might not be the same as the calendar year.
The amount you pay for your health insurance coverage, either in a lump sum or through installments.
The written instruction for medicine that a licensed medical professional provides. The abbreviation for prescription is Rx.
Steps taken to prevent illness; for instance, routine check-ups and screenings.
Health services that cover a range of prevention, wellness, and treatment for common conditions and injuries. Primary care providers include general practitioner doctors (GPs), nurses, and physician assistants.
Prior authorization (PA)
Also known as a “coverage review,” this is a process health plans might use to decide if your prescribed medicine will be covered. Plans use this to help control costs and to ensure the medicine being prescribed is an effective treatment for the condition.
The maximum amount of a medicine a health plan covers during a certain period of time. These limits are set for safety reasons and to help reduce costs. If your doctor prescribes more medicine than your plan allows, the doctor will have to contact the plan to approve the amount.
A written order from your primary care doctor for you to see a specialist or to obtain certain medical services. If you don’t get a referral first, your plan might not pay for the services.
When your doctor writes your prescription, it might include a certain number of refills. This means you can continue to get the medicine refilled until the prescription expires. Once your prescription expires, it requires a renewal before you can get another refill.
After a prescription expires, a doctor needs to renew it. A renewal is a new prescription, even though it might be for the same medicine and the same dose you’ve been taking. Your doctor might want you to schedule an appointment or get some test results, before renewing your prescription. This helps make sure the medicine is still treating your condition as it should. Although many people think of a renewal as just another refill, a renewal is different because it’s a new prescription.
Rx number (prescription number): a unique number given to every prescription. You’ll find the number on the prescription label.
Specialty medicine is used to treat complex and long-term conditions, and usually has to be stored or handled in special ways. People take specialty medicines for conditions, such as multiple sclerosis, rheumatoid arthritis, or hemophilia. If you're taking a specialty medicine, you can find services through our specialty pharmacy Accredo.
A process designed to help control high medicine costs. If your plan applies step therapy to your prescription, it will require that you try a lower-cost medicine that’s proven effective to treat your condition, before it will cover a higher-cost medicine. If the lower-cost medicine does not treat your condition effectively, your plan’s coverage will “step” you to a higher-cost medicine to find a medicine that treats your condition effectively at the lowest possible cost.
The amount of long-term medicine you use during a three-month period. In most cases, prescriptions for long-term medicine are written for a three-month supply. The actual quantity or days' supply you receive depends on your plan's rules.
Total annual copayment
The total copay amount you spend on prescriptions during a one-year period.
- Your copay is $7 for a 3-month supply of medicine with delivery from TRICARE Pharmacy Home Delivery.
- You fill this medicine every three months, which is 4 refills per year.
- Your total annual copay is $7 x 4 = $28.
Total daily dose
The total amount of a medicine you take in a 24-hour day. You’ll need to know this number in order to get pricing details for your medicine using our Price a Medication tool.
To calculate your total daily dose, multiply the amount of medicine by the number of times you take it every day.
- You take 2 tablets 4 times per day.
- Your total daily dose is 2 x 4 = 8.
If you can’t find the answer to your question, please contact us.