Smart90 Program FAQs
What is Smart90?
Pinellas County’s prescription plan for employees includes the Smart90 Program. Smart90 is an exclusive pricing agreement with Express Scripts and Walgreens. This program provides discounts on maintenance prescription drugs for Pinellas County and its covered individuals.
Long-term medications for chronic conditions must be prescribed in 90-day supplies and filled by your local Walgreens pharmacy or by Express Scripts home delivery, unless you find a lower-cost alternative.
What is a maintenance medication?
A maintenance medication is used on an ongoing basis (three months or longer) for a long-term or chronic condition. Examples include:
- Asthma medication
- Birth-control pills
- Blood pressure medication
- Cholesterol medication
- Eye drops
- Topical creams
The Express Scripts Maintenance Medications List provides a comprehensive summary of most covered medications. This list is subject to change.
What is a long-term condition?
Long-term or chronic conditions are those which require regular doses of medication to provide treatment in order to improve or maintain the health of the patient. Examples of chronic conditions are high blood pressure, diabetes, COPD, depression and asthma.
What if I fill a prescription at a pharmacy other than Walgreens?
- For short-term medications typically taken for up to 30 days—like antibiotics for an acute illness—you can fill the prescription at any pharmacy. The cost is subject to copay or coinsurance.
- For a long-term maintenance medication, if you do not fill the prescription at Walgreens or Express Scripts home delivery, then you will pay the full cost of the medication unless you find a lower-cost alternative.
What does “full cost” mean?
“Full cost” is the actual cost of your medicine. For example, the actual cost for a 90-day supply of the medicine might be $381. But if you have a copay or coinsurance, then your payment might only be $30. “Full cost” means that you would pay the entire $381.
What if I get 30-day supplies?
If you get a 30-day supply instead of 90-day supply of a maintenance medication, then you will pay the full cost of the medication after two 30-day fills.
What if I find a lower-cost alternative to purchase my medication?
You do not have to use Walgreens or Express Scripts home delivery if you find a lower-cost alternative. You should be a smart health care consumer and make the best choice for yourself. Smart90 does not prevent the use of cost-saving options like discount cards, drug manufacturer assistance or going to another store. There are websites with price comparison lists, including Express Scripts.
Does a manufacturer coupon count toward my deductible and out-of-pocket maximum?
Only the amount you pay out-of-pocket when using manufacturer coupons will be applied toward your deductible and out-of-pocket maximum.
How can I find out how much a medication will cost?
- Ask your pharmacist.
- Log into the Express Scripts website or the Express Scripts mobile app, and select Price a Medication from the Prescriptions menu to view your options.
Are there drawbacks to using more than one pharmacy?
If you obtain medications from more than one pharmacy, be sure the pharmacist knows about any other medications you are taking in order to monitor drug interactions.
What about a new prescription? It doesn’t make sense to order a 90-day supply before I know if it works.
A prescription for a medication that is new to you is not subject to the Smart90 Program. You may fill a prescription for a new maintenance medication twice in 30-day quantities. On the third fill, you need to order a 90-day supply or pay the full cost of the medication.
What about prescriptions that are only available in a 30-day supply?
If a prescription is only available in a 30-day supply, then it is not subject to the Smart90 Program. You may fill such a prescription in 30-day quantities for the regular copay and coinsurance.
How does the Smart90 Program work for Choice Fund Open Access Plus HSA (previously called the Consumer Driven Health Plan) participants filling a preventive medication?
In order to get a 90-day supply, you need to use Walgreens or Express Scripts home delivery. A 30-day supply may be filled at any retail pharmacy. In either case, the cost is covered at 100% for a preventive medication.
What about allergy shots?
Medicines administered in a treatment setting such as a doctor’s office or hospital are not part of the Express Scripts program and are not included in the Smart90 Program. They are covered by your Cigna medical plan.
Home Delivery FAQs
How do I sign up for Express Scripts home delivery?
Visit Express Scripts or call Express Scripts at (866) 544-9221 to say you would like your medicine delivered.
Do I have to pay shipping with Express Scripts home delivery?
No. There is free standard shipping with Express Scripts home delivery.
Can I get automatic refills of my prescriptions?
Yes. Log on to Express Scripts. Select the Prescriptions tab and Automatic Refills for details.
If I change to home delivery, how soon will my medicine be delivered after I order?
Orders are usually processed 48 hours from when they are submitted. Your medicine should be delivered in about eight days (or 10-14 days if it’s a new prescription). Please have a one-month supply of your medicine on hand when you place your order. You can check your order status by going to Express Scripts.
Won’t the heat in my mailbox damage the medication if it sits there all day?
If the medication being delivered to your home needs refrigeration, then Express Scripts will make sure it is packaged appropriately. All of your medications will be delivered in a confidential, tamper-proof, weather-resistant package.
If I use home delivery, can I talk with a pharmacist?
Yes. Express Scripts pharmacists are available 24 hours a day, seven days a week for private consultation. An average of one in 10 patients speaks with an Express Scripts pharmacist for an average of 12 minutes. This compares with an average of one in 25 customers who talk with a retail pharmacist for an average of two minutes.
Is there a payment plan available for home delivery?
Yes. Express Scripts offers an extended payment plan that lets you pay for your home delivery medications in three monthly installments, instead of paying the full amount all at once.