FSBP Prescription
Coverage and Programs

We work closely with Express Scripts to provide you with pharmacy benefits

FSBP ensures that you have access to high-quality, cost-effective medications through a network of retail pharmacies and by convenient home delivery. Prescription drug copayments and out-of-pocket costs are split into tiers. Click here to see prescription costs and benefits chart. 

Automatic Prescription Refills

The automatic refills program is designed to help you never run out of your long-term medicine. After you enroll your prescriptions in the program, Express Scripts will calculate your long-term prescription usage and days’ supply remaining automatically. When it’s time to refill, Express Scripts will fill the prescription and mail it to you. You’ll also receive notification 7 days before Express Scripts begins to process your next refill. You have the option to change the next processing date or cancel the prescription from the Automatic Refill program any time before processing begins.

There are 3 convenient ways to enroll:

  1. Log onto your Express Scripts Online Portal account and click “Manage Automatic Refills” from the menu under “Manage Prescriptions.” Select the prescriptions you want refilled automatically.
  2. At the time you refill a prescription, the system asks if you want to enroll it in automatic refills. If you answer “yes,” Express Scripts will begin refilling your prescription automatically.
  3. Call Member Services at 800-818-6717 and tell the patient care advocate you want to enroll in automatic refill

Home Delivery: 30/90 Program and Overseas 1-Year Supply

Your home delivery prescriptions are the most cost-effective for you when they’re filled in a 90-day supply. If the Express Scripts Pharmacy receives an eligible prescription written for less than a 90-day supply (typically between 21 and 75 days), the pharmacy will take one of these steps:

  • If the prescription was written in a state that allows “consolidation” and has refills, the pharmacy will automatically fill it in the maximum quantity allowed by the Plan (typically 90 days).
  • If the prescription was written in a state that does not allow consolidation, the pharmacy will attempt to contact the prescriber for approval to fill it in the maximum allowed quantity. If approval isn’t received, the prescription will be filled in the original quantity with no delay for the patient.

If you are or will be overseas and would like to purchase a 1-year supply: 

Your doctor needs to write the prescription for a full year’s supply with no refills, and you need to pay the full-year copayment/coinsurance. Orders can be shipped only to addresses in the U.S. or to APO, FPO, DPO, and Pouch Mail addresses. Please allow extra time for this process to take place to be sure you will receive your medications in a timely manner. Please see Home Delivery Foreign Countries for more details. The Plan cannot mail prescription medications to Germany per German regulation. Please be advised of the Rx restrictions for Japan that can be found here

Smart90®

Smart90® gives another option for obtaining 90-day supplies of your non-specialty maintenance medications. With Smart90®, you must fill a 90-day supply of your maintenance medications at a participating retail pharmacy. But you will pay less for each 90-day supply than you would pay for three 30-day supplies at a retail pharmacy.

Here’s how it works:

Obtain a 90-day supply of your non-specialty maintenance medications by filling your prescription at a preferred 90-day retail pharmacy (CVS, Walgreens and independent pharmacies). You can search for a participating Smart90® pharmacy by:

  1. Logging in or registering at http://express-scripts.com/90day
  2. Select “Manage Prescriptions”
  3. Look for a link directing you to the Participating Smart90® Retail Network pharmacies

FSBP Prescription Benefit Highlights – Home Delivery

Specialty Medications

Specialty medications are used to treat complex conditions, including cancer, cystic fibrosis, hemophilia, hepatitis C, HIV, and multiple sclerosis. Typically, they are injectable and require special handling. By filling specialty prescriptions through Accredo, an Express Scripts specialty pharmacy, you’ll pay only your plan’s copayment and receive a variety of specialized services – the kind you may not get from your retail pharmacy.

  • Safe, prompt delivery. Accredo will schedule and ship all your specialty medications quickly, including those that require special handling such as refrigeration.
  • Supplies. Most supplies, such as syringes, needles, and sharps containers, will be provided with your medication.
  • Refill reminders. Accredo will contact you regularly to schedule your next refill and see how your therapy is progressing. For convenience, some specialty medication refills can be ordered online, safely and securely, through the Express Scripts Online Portal.
  • Drug safety monitoring. As an Express Scripts pharmacy, Accredo can access your prescription information on file at all Express Scripts pharmacies to monitor for potential drug interactions and side effects of your medications.


Important:
 Most specialty drugs require prior authorization. Also, certain specialty drugs must be ordered from Accredo to receive coverage. They will not be covered if ordered from a retail pharmacy, your prescriber’s office, or an outpatient facility. If you purchase these drugs from a retail pharmacy, you will pay 100% of the drug cost. Click here to learn more.

Opioid Medications

Opioid addiction cuts across all walks of life, impacting you, your family, your neighbor, your colleague, your babysitter. After just ten days on a prescription opioid, one in five people become long-term users. For those who overdose, the average time between first dose and death is only two and a half years. Most startling: we are losing 90 lives to pain killers every day. Together, we can fight the growing weight of these statistics. Together, we can fight this epidemic.

The Office of Personnel Management (OPM) has encouraged all plans in the Federal Employees Health Benefits Program to take action and help members using opioid medications (opioid therapy). Accordingly, if your doctor prescribed an opioid for you, you may notice some extra precautions the Foreign Service Benefit Plan (FSBP) is taking around patient education, care, and proper disposal of unused medication.

  • When you fill your first prescription for a pain medication classified as an opioid, you will receive an educational letter from Express Scripts explaining what Opioids are and how to use them safely.
  • To ensure the safe use of these medications, your prescription may have quantity limits and may require prior authorization.
  • If you continue on Opioid therapy, you may receive a call from a specialist pharmacist to provide education on potential risks, as well as, safe use and proper storage and disposal.

Together with our pharmacy benefit manager, Express Scripts, we are focusing our efforts across all points of care when it involves opioid prescribing to ensure your safety and well-being.

Naloxone-based rescue agents

FSBP covers Naloxone-based rescue agents at 100% when obtained at network retail, network home delivery and out-of-network retail (outside the 50 United States).

For more information, refer to Section 5(f), Prescription Drug Benefits, of the FSBP Brochure.

The Personal Medication Coach Program improves the way you manage your medications. We will contact candidates and invite them to participate in the Program that includes a Personalized Medication Assessment.

During a Personalized Medication Assessment, the pharmacist conducts a comprehensive review of your retail and mail medications (including OTC medications) and assists you in taking an active role in managing your multiple medications. This is accomplished by providing helpful information, education and support around adherence, the proper use of the therapy prescribed as well as drug-drug alerts (if appropriate) and formulary alignment.

At the conclusion of a Personalized Medication Assessment, we will mail an Individual Medication Record and a Medication Usage Plan. The Individual Medication Record provides you with a general overview and summary of your pharmacy claims and history. The Medication Usage Plan includes best practices for taking medications and questions to ask when starting a new medication.

As part of the program we will perform regular Individual Prescription Reviews (IPR) with you. These reviews focus on treatment guidelines, safety issues, and cost savings. We contact your prescriber as needed, based on information from the IPR, to request an addition or change to drug therapy, information about drug-to-drug interactions, or safety issues.

Therapeutic Resource Centers (TRCs)

As part of your plan – and at no cost to you – the specialist pharmacists from Express Scripts TRCs focus on medication safety for patients with chronic and complex conditions. They’re specially trained in medications to treat conditions including diabetes, heart disease, high cholesterol, high blood pressure, cancer, migraines, asthma, and hemophilia. Specialist pharmacists can answer your medication questions, help you avoid harmful drug interactions, and even help you and your doctor identify potential medication savings.

To speak with a specialist pharmacist, call Express Scripts at 800-818-6717 or log into your Express Scripts Online account, choose “Health Resource Center,” and click the link to ask your question.

SafeGuardRx

SafeGuardRx is a suite of programs that address specific chronic therapeutic conditions and focuses on reducing cost and improving care while ensuring members receive appropriate therapy and specialized care for their condition to achieve better therapy outcomes and remain adherent. The programs may include prior authorization, step therapy and quantity limits. Some medications may be preferred over others based on FDA indications. These programs may require that you receive your medications from a specific network pharmacy and/or Home Delivery. Medications used to treat high cholesterol, diabetes, asthma/COPD, migraines and multiple sclerosis are a few of the targeted therapies.

To find a specific network pharmacy participating in the SafeGuardRx program in the United States or to obtain additional information, contact Express Scripts at 800-818-6717.

Express Scripts Specialist Pharmacists Program

For those who need the highest degree of clinical support, Express Scripts enables members and their caregivers to engage with highly trained specialist pharmacists and nurses. The specialist pharmacists specialize in caring for patients with the most complex and costly conditions, including cardiovascular disease, diabetes, cancer, HIV, asthma, depression, and many rare and specialty conditions.

For direct access to a specialist pharmacist, call 800-818-6717 or log on to express-scripts.com. If you have further questions, send them here.

FSBP Prescription Costs

The table below provides an overview of what you will pay for prescription drugs:

YOU PAY
Tier LevelRetail Network Pharmacy (30-Day Supply)Home Delivery From Express Scripts or Participating SMART90 Retail Network Pharmacy (90-Day Supply)Out-Of-Network Retail Pharmacy in the U.S.Retail Pharmacy Outside the U.S. Including Military Treatment Facility
Tier I (Generic Drugs) $10 copay $15 Copay Full retail price of drug 10% of the cost (You pay full price, file a claim, and receive 90% of the cost of covered drugs.
Tier II (Preferred Brand Name Drugs) 25% of drug cost ($30 minimum; $100 maximum) $60 copay Full retail price of drug 10% of the cost (You pay full price, file a claim, and receive 90% of the cost of covered drugs.
Tier III (Non-Preferred Brand Name Drugs) 35% of drug cost ($60 minimum; $200 maximum) 35% of drug cost ($60 minimum; $200 maximum) Full retail price of drug 10% of the cost (You pay full price, file a claim, and receive 90% of the cost of covered drugs.
Tier IV (Generic Specialty Drugs) 25% of drug cost Up to $150 maximum 25% of drug cost Up to $150 maximum Full retail price of drug 10% of the cost (You pay full price, file a claim, and receive 90% of the cost of covered drugs.
Tier V (Preferred Brand Name Specialty) 25% of drug cost Up to $200 maximum 25% of drug cost Up to $200 maximum Full retail price of drug 10% of the cost (You pay full price, file a claim, and receive 90% of the cost of covered drugs.
Tier VI (Non-Preferred Brand Name Specialty Drugs) 35% of drug cost Up to $300 maximum 35% of drug cost Up to $300 maximum Full retail price of drug 10% of the cost (You pay full price, file a claim, and receive 90% of the cost of covered drugs.

Purchasing routine medications via home delivery from the Express Scripts Pharmacy or participating Smart90® Retail Network pharmacies may lower your out-of-pocket costs significantly. 

Choose potential lower-cost alternatives for your medications

FSBP strongly encourages all members to use lower cost alternatives shown in the Price a Medication tool or on the Express Scripts mobile app. In many cases, a doctor can prescribe a less costly and clinically appropriate alternative drug that will perform just as well as another drug. Talk to your doctor to discuss whether a lower-cost alternative is right for you and is appropriate for your health needs. 

Note: Medications that are considered prescription drugs outside of the 50 United States, but are non-prescription (over-the-counter) medications in the 50 United States, are covered.