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Important Pharmacy Claims Processing Change, Effective January 1, 2024

September 27, 2023

We are pleased to announce that, effective January 1, 2024, Express Scripts® will begin processing pharmacy claims for our plan members.

Express Scripts is a pharmacy benefit management (PBM) company serving more than 100 million Americans. Express Scripts Pharmacy® delivers specialized care that puts patients first through a smarter approach to pharmacy services.

Members have been notified in advance and will receive a new ID card with updated pharmacy information, so that they are prepared to begin having their prescriptions filled at participating network pharmacies when this change occurs.

Providers can direct members to call the Member Services phone number listed on their ID card should they have questions about this change.

Please contact your Provider Relations Representative with any additional questions.

Thank you for the care you provide to our members.

Express Scripts Transition: Frequently Asked Questions 

This FAQ provides additional information on the migration of our Pharmacy Benefit Manager (PBM) services from CVS® to Express Scripts®, effective January 1, 2024.

Who is Express Scripts?

Express Scripts is a pharmacy benefit management (PBM) company serving more than 100 million Americans. Express Scripts Pharmacy delivers specialized care that puts patients first through a smarter approach to pharmacy services.

What is the rationale for changing PBM vendors?

Express Scripts as our PBM will bring increased levels of transparency and value, positioning us to provide the highest level of quality at the lowest possible cost to our members.

What PBM services will Express Scripts be providing?

Express Scripts will be the PBM of record providing pharmacy claims adjudication, pharmacy network administration and rebate administration on behalf of our health plan.

How will this PBM transition impact our members?

There will be no immediate change in service for our members, although they will receive new ID cards. We will continue to provide the same member-focused care and support as we do today.

Our highest priority continues to be serving all our members, and we remain committed to providing affordable quality healthcare services. Our team is working closely with both CVS and Express Scripts to ensure a seamless migration.

Is Amazon part of the Express Scripts Network?

Yes, Amazon is part of the Express Scripts network.

Can members still use CVS Caremark for their mail orders?

No, CVS Caremark Mail Service Pharmacy will be out of network, effective January 1, 2024. If members wish to continue using mail order in 2024, they must switch to Express Scripts Pharmacy.

Do members have a choice besides Express Scripts for mail order services?

Members have a choice to use other pharmacies that offer home delivery, but Express Scripts Pharmacy is the preferred mail order pharmacy for our health plan.

Are we communicating this mail order change to members?

Yes. Impacted Medicaid members will receive a Mail Order Change notification letter.

How will members get started with mail order at Express Scripts?

For existing mail order users:

  • Most open prescription refills will be automatically transferred to Express Scripts
  • Refills for controlled drugs, such as Alprazolam, Clonazepam, Pregabalin, Tramadol, Zolpidem, etc., will not automatically transfer to Express Scripts Pharmacy; members must request a new prescription from their provider

For new mail order prescriptions on or after January 1, 2024, members may do one of the following:

  • Ask their provider to electronically submit or fax a new prescription to Express Scripts Pharmacy, as listed on their medical ID cards
  • Visit to register or sign in, then follow the guided steps to request a prescription
  • Call Express Scripts Pharmacy, who will contact their provider for a new prescription to be filled via mail order
  • Mail a Home Delivery Order Form (available at directly to Express Scripts Pharmacy

Does Express Scrips offer a mail order app?

Yes, members will be able to download the Express Scripts Pharmacy app, available on the App Store and Google Play. Members with a mail order benefit can order medications, track delivery and more.

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