Non-Medicare Pharmacy Benefits

Express Scripts Inc administers the prescription drug benefits on your WSHIP plan. Express Scripts Inc is a leading pharmacy benefit manager with the nation's largest mail order pharmacy operations, including over 1,100 specialist pharmacists trained in specific chronic conditions, and more than 60,000 participating retail pharmacies. If you have questions about your pharmacy benefits, please call Express Scripts Inc Member Services at 1-800-859-8810.  

Prescription Drug Plan Information

• Review our prescription drug benefit highlights
• Find participating retail pharmacies near you (and get driving directions)
• Check medication coverage and pricing

www.express-scripts.com/wship

Learn about Three-Tiered Pharmacy Benefits 

View our Preferred Prescriptions Drug List (Formulary)

Your prescription drug benefit includes the Express Scripts National Preferred Formulary, which is a list of commonly prescribed brand-name and generic medications. The medications included in the formulary, which is evaluated and approved by an independent body consisting of physicians and pharmacists located throughout the U.S., are selected because they can safely and effectively treat most medical conditions while helping to contain overall costs.

Download Preferred Prescriptions® Member Guide - National Preferred Formulary.
Download Preferred Prescriptions® Member Guide - National Preferred Formulary Exclusions.

NOTE:  This guide is a partial list containing many commonly prescribed medications.  For the most complete and up-to-date information log on to www.express-scripts.com or contact Express Scripts Inc Member Services at 1-800-859-8810. Prospective members can access benefit information at www.express-scripts.com/wship.

Learn about Coverage Reviews 

Your prescription drug benefit includes programs that help manage costs while ensuring that you have access to the medications you need. These programs use plan rules based on FDA-approved prescribing and safety information, clinical guidelines, and uses that are considered reasonable, safe, and effective.

With these programs, some medications may not be covered unless you receive approval through a coverage review. There may also be a maximum quantity or dose that’s covered by your plan for certain medications. If you submit a prescription for a medication that has coverage limits, your pharmacist may fill the prescription up to the amount allowed. If the prescription exceeds the amount allowed by your plan, a claim rejection message will alert the pharmacist and indicate that a coverage review is required to process the claim for an amount above the quantity limit. During a coverage review, Express Scripts Inc asks your doctor for information beyond what is on the prescription in order to determine if the medication or quantity/dose may be covered under your plan.

How to request a coverage review:

Your pharmacist will let you know if your prescription requires a coverage review (also called “prior authorization”). Often times, the pharmacist will call your doctor for you or you may call Express Scripts Inc Member Services for assistance in requesting a coverage review. Your physician requests a coverage review electronically by visiting www.esrx.com/pa or by calling Express Scripts toll-free at 1-800-753-2851. Reviews completed electronically or via phone can be completed in the most efficient manner (sometimes within a couple hours), compared to a doctor’s choice to communicate with Express Scripts Inc. via fax. An appeals process is available for any denied cases. For coverage information on the drugs you are currently taking, log on to www.express-scripts.com, select “Price a Medication” from the menu under “Prescriptions,” and search for your medications. Enter your drug’s name and click “Search.” On the pricing results page, select “View coverage notes” to see coverage details.

Download Pharmacy-Related Forms