Express Scripts

I love everything about express scripts except the prior authorization process. It’s not until a physician prescribes a medication that we find out it requires prior authorization and after the script is received by express scripts then a form for prior authorization (pa) form or letter is sent to the provider. It slows down the actual receipt of the medication. I was prescribed a certain medication and after it was received we were told a PA was required then the provider sent an alternative and it was sent a prior authorization form in the denial we were told we needed to use 3 other forms of medication first with poor results. One of the three options was the first medication that also needed prior authorization. In this way the most money is saved but the patient goes untreated for much longer. It’s been over 3 months and I’m still untreated. The formulary does not really help because it’s not updated regularly so we can’t find out easily if PA is required. I know Tricare is the actual culprit but Express Scripts is the messenger. It relies on each individual physician and their staff to provide the PA forms. So I’m very dissatisfied with this part of the “service” provided.

Our company switched to Express Scripts in Jan 2024 after being with OptumRx for 9 years — I have had nothing but problems with just about every prescription I have had to get filled — and especially refilled. First, every thing needs a pre-authorization- no problem. However, a 2nd pre-authorization seems to be always needed. If it’s pre-approved why does it need to be pre-approved again? Literally every single doctor I’ve used is frustrated with Express Scripts— that absolutely hate Accredo. Verbatim, their words. I have called Xpress scripts customer service so many time I’ve lost count. Every time I’m told - no problem the prescription will be filled only to get a robocall or text later saying the exact prescription can’t be filled…a prior authorization is needed!!!! Over and over, round and round. I missed one medication for over a month with this nonsense. It doesn’t matter if I go to my local pharmacy or get it mailed. Same issue. Then there are the subcontractors Accredo and Senderra who are even less helpful and despite all 3 companies being worth billions of dollars— cannot seem to connect their databases together— 5 different doctors I’ve used have had issues placing prescriptions. They have said they unfortunately have to deal with this kind of nonsense specifically with Xpress Scripts. What is so different about your prior authorization process that 5 different doctors have all had the same issues? I mean what are the statistical odds? Seems to be 1 common denominator here…

The app is extremely misleading. It leads you to believe you have a refill when you don’t. If you order a refill, and didn’t have one available then your doctor is contacted. I don’t want my doctor contacted unless I authorize it. Furthermore, many medication’s are available generically and can be billed to a good RX or other coupon at the walk-in drugstore for less than insurance price or cash price. Express scripts is very greedy and they won’t honor these coupons. furthermore, they try to charge astronomical prices, calling certain medication’s specialty, when, in fact, they have many off label use and can be purchased for as little as $20 cash. Once your prescription is sent to Xpress scripts and not fillable thru insurance or their own incompetence or otherwise laziness, it’s impossible to get it back out of there easily. the only thing this service is good for is filling prescriptions that you have a refill on that are cheap, covered by insurance and need to be refilled regularly. The app needs many improvements. they should have to return to the customer a printed copy of every electronic prescription that they mishandle and do not fill in the manner requested by me, the customer. generics, utilize, or a 50-50 chance. You either get a quality one that is made in the USA, or end up with a very inexpensive generic, made outside of the USA. I haven’t tried to order a specific generic company, because I don’t want to be on hold for that long.