Do I need to pre-certify in order to receive prescription drug benefits?

In order to qualify for coverage, certain medications require pre-certification in order to determine the appropriateness of the drug in treating your condition. If you file your prescription through Express Scripts, their pharmacist will initiate the pre-certification review with your doctor. If you visit a retail drugstore, your pharmacist will let you know if your medication requires pre-certification. If so, your doctor must call a special toll-free number at Express Scripts to initiate a review. This process typically takes one or two business days. Once the review is complete, Express Scripts will notify you and your doctor of the decision. If the review is approved, you will receive a letter indicating the length of approved coverage. If the review is denied, the letter will include the reason for denial and instructions on how to submit an appeal if you choose.