You will need to file a claim for reimbursement if:
You must file your claim within one year of the date of service.
Required Info with Your Claim
|CAN'T be Handwritten on the EOB or Pharmacy Receipt
||CAN be Handwritten on the EOB or Pharmacy Receipt
- Date of fill
- Pharmacy name
- What you (the beneficiary) paid
- Drug name and strength
- Number of day’s supply
- Prescription number
- Pharmacy address
- Doctor’s name or DEA number
- Pharmacist’s signature (for retail pharmacy claims only)
- Amount paid by the other health plan or the retail price from the pharmacy
Claims Filing Addresses
In the U.S. or a U.S. Territory, file your claim with the pharmacy contractor:
Express Scripts, Inc.
P.O. Box 52132
Phoenix, AZ 85072-2132
In an overseas area (other than a U.S. Territory), file your claims with the overseas claims processor, at the appropriate address.