Citi Benefits Handbook
Controlled Substances with Express Scripts
Upon request, Express Scripts will fill prescriptions for controlled substances for up to a 90-day supply, subject to state limits (and any Program limits).
Because special requirements for shipping controlled substances may apply, Express Scripts uses only certain home delivery pharmacies to dispense these medications. If you submit a prescription for a controlled substance along with other prescriptions, it may need to be filled through a different pharmacy from your other prescriptions. As a result, you may receive your order in more than one package.
For more information about controlled substances and the laws in your state, call Express Scripts at 1 (800) 227-8338.
Note: Kentucky and Hawaii state laws require you to provide your Social Security number or government ID to the pharmacy or to Express Scripts before it can dispense your medication(s).
How the Controlled Substance Processing Works
Controlled substance restrictions:
- The Food and Drug Administration (FDA) does not allow refills on Class II controlled substances. A new prescription must be presented each time the medication is filled.
- The Drug Enforcement Administration (DEA) requires presentation of a hardcopy on Class II prescriptions. They cannot be phoned or faxed into ANY pharmacy. They can, however, be e-prescribed by prescribers who have DEA certified systems and whose states allow for e-prescriptions for Class II drugs.
- The DEA mandates that prescriptions for Class III - Class V medications must be expired six months from the date that they are written. Note: Express Scripts must comply to any state regulations that are stricter than federal regulations.
- Express Scripts Pharmacy fills all controlled medications out of its St. Louis facility. There is a very stringent verification process that takes place. The pharmacist reviews the actual hardcopy against the system entry prior to releasing for fulfillment.
Special requirements for controlled substance processing:
- Controlled substances require very specific information to be present on the prescription in order to be processed by Express Scripts. In the majority of cases the information required is missing upon original receipt of prescriptions.
- A hand signature is required on all prescriptions for controlled substances. Any controlled prescription with an electronic or missing signature requires pharmacy outreach to the physician. (Electronic signatures on e-prescriptions, where allowed, are acceptable.)
- A valid DEA number is required on all controlled substance prescriptions. If the DEA number is present, technicians must validate the DEA number. If the DEA number for the prescribing physician is NOT present or is invalid, pharmacy outreach to the physician is required.
- A physical address on file is required for all controlled substances. A physical address must be obtained if the address on the prescription or in our system is a P.O. Box. A medical reason is required for any Class II prescriptions being dispensed over a 30-day supply regardless of the state where the prescription is issued. A medical reason can either be a diagnosis or a detailed description. For example, "chronic pain" would not be sufficient, but "cervical pain unresolved by surgery" or "stabilized ADHD" would be sufficient. Going off to college is not an acceptable medical reason.
Process for making outreach:
- A technician or pharmacist (depending on the information needed) is responsible for making the necessary outreach to the physician's office or to the patient by phone, fax, or electronic communication.
- The prescriber's office or patient has two business days to respond. If clarification is obtained, the prescription image will be annotated and the prescription will continue along in the processing. If not received, the script will be routed to the interventions team who will make additional attempts to contact the physician and or patient for resolution.