Pharmacy Benefits

Mail Order Pharmacy

If you have prescriptions for a long-term condition and your pharmacy benefit includes mail order, getting your drugs through the mail may be a convenient option for you.

Medica offers pharmacy mail order through Express Scripts^® Pharmacy. You'll receive a 90-day supply of your medication through the mail, with no shipping or handling fees.¹

Before Signing Up for Mail Order

• Verify that your pharmacy benefit includes mail order. You can check your coverage document, available on Medica.com/MemberSite, or call Customer Service at the number on the back of your Medica ID card.
• Register on the Express Scripts website through your portal at Medica.com/MemberSite.
• Talk with your doctor to make sure it's OK to order a 90-day supply of your medication.
• Check pricing at your retail pharmacy. Depending on your benefits, you may find that it's less expensive to continue getting your medications at your local pharmacy. You can compare costs using the Price a Medication tool on the Express Scripts website, which you can access through Medica.com/MemberSite.

How to Fill Mail Order Prescriptions

You can easily request prescription fills using the Express Scripts website, which is accessible through Medica.com/MemberSite, using the Express Scripts mobile app or by calling Express Scripts. Express Scripts representatives are available 24 hours a day, seven days a week at 1-800-263-2398 (TTY: 711). Have your Medica ID card ready. You also have the option to complete and submit the Mail Service Order Form below.

Allow up to 10 business days for your order to arrive.

Home delivery order form (PDF)

Keep Your Information Current

If you move or need to change your delivery address (e.g., if you head south for the winter), let Express Scripts Pharmacy know by calling the number above at least 10 days before your next refill.

If any of your other account information changes — for example, payment details, insurance information, health conditions, etc. — be sure to call Express Scripts Pharmacy to let them know. Any information you provide is kept confidential and secure in accordance with national and state privacy laws.

For ongoing medications, you can get up to a 90-day supply at one time from a participating pharmacy. You'll pay three retail copayments or coinsurance amounts (depending on your plan) and get the convenience of saving trips to the pharmacy.

How it Works

For a new prescription:

• Ask your doctor for up to a 30-day supply of the medication on one prescription. This lets you first try the drug to make sure the dose and drug work for you.
• Also ask for a second prescription for up to a 90-day supply of the same medication. You can fill this once you and your doctor know that the medication is right for you. Just bring the prescription to a participating Retail 90 pharmacy and present your Medica ID card.
• Your pharmacist will fill the prescription and you'll pay the amount you owe.

For refills:

• Ask your doctor to write a prescription with refills for up to a 90-day supply of your medication.
• Bring the prescription to a participating Retail 90 pharmacy and present your Medica ID card.
• Your pharmacist will fill the prescription and you'll pay the amount you owe. 

For more information about Retail 90, call Medica Customer Service at the number on the back of your Medica ID card.

Specialty drugs are used to treat certain complicated health problems. These drugs tend to be very expensive and may need special handling and monitoring.

For most specialty medications, you'll use Accredo Specialty Pharmacy, our preferred Specialty Drug Program vendor, to fill your prescriptions. There are a small number of drugs not available through Accredo Specialty Pharmacy. Discuss your options about these limited distribution drugs with your prescriber. 

Filling a New Specialty Drug Prescription

If you need to fill a new specialty drug:

• Check the specialty drug list, which shows all of the medications Medica considers specialty drugs.
• Your plan may not cover all of the drugs on the specialty drug list, so check your coverage document on Medica.com/MemberSite, or call the Customer Service number on the back of your Medica ID card for your specific benefits. 
• Once you've verified your benefits, have your prescription filled through Accredo Specialty Pharmacy. If you fill your specialty drug prescription through a vendor other than Accredo Specialty Pharmacy, your drug will not be covered and you will be responsible for the entire cost.²

Refilling your Prescription

After your first fill, you can create an account on Accredo's Patient Portal to view and manage your refills. You will need an active Accredo prescription number to register on the portal.

Access Accredo Patient Portal

You can also request a refill by phone:

Accredo Specialty Pharmacy
Phone: 1-866-544-6817 (toll-free) (TTY: 711)
Monday through Friday 7 a.m. – 10 p.m. Central
Saturday 7 a.m. – 4 p.m. Central

A brand-name drug is protected by a patent for a certain amount of time. That means only one manufacturer can make the drug during that time. Once the patent expires, generic versions of the drug are often introduced.

Generic drugs have the same active ingredients as their brand-name counterpart and must meet the same quality standards as brand-name drugs, but are generally less expensive.

Both brand-name and generic drugs are regulated by the Food and Drug Administration (FDA).

Yes. A team of physicians and pharmacists regularly reviews new and existing drugs to be sure the drug list continues to meet our members' and providers' needs. Drugs may be added to the list at any time during the year; however, Medica strives to limit removing drugs to no more than twice a year.

If a generic equivalent becomes available for a brand-name medication on our drug list, we may update the list to only include the generic as the preferred drug. If a change to the list affects a drug you are taking, we’ll send you a letter telling you about the change.

Specialty drugs are used to treat certain complex health problems. These drugs tend to be very expensive and may need special handling and monitoring. For most specialty medications, you'll use Accredo Specialty Pharmacy to fill your prescriptions.*

*Or through the designated specialty pharmacy vendor if it's a limited distribution drug.

Step Therapy is a program focused on using cost-effective prescription drugs as first-line treatment when appropriate. The program is used for certain conditions where there are many treatment options available. Drugs that require Step Therapy are noted on the drug list. Some drugs may also require prior authorization.

In Step Therapy, you try the Step 1 preferred drug or drugs first. Step 1 drugs are cost efficient and effective options. If the Step 1 drug isn't effective, you can then try the Step 2 drug. In some cases, you may need to try more than one Step 1 drug before trying a Step 2 drug.

Step Therapy applies to all members, regardless of their plan type. That means that if you don't try the Step 1 drug or drugs first, then a Step 2 drug won’t be covered. Your doctor may request an exception if your current drug is the best clinical option for you. If authorization is given, we’ll continue coverage of your current drug. If the request is denied, you may appeal the decision.

Prior Authorization is approval given by Medica for coverage of a certain medication. Medications that require Prior Authorization are noted on the drug list with a "PA" next to the drug name. As a provider in the Medica network, your doctor will know how to request Prior Authorization.

Your doctor can request an exception to the drug list by visiting Medica.com/RxPA.

Yes. If your exception request is denied, Medica will send you a letter explaining your right to appeal and the process for the appeal. You can also call Medica Customer Service at the number on the back of your Medica ID card and tell the representative that you wish to appeal a decision.