Express Scripts Formulary: Preferred Drug List Exclusions

Publication Date: 02/04/2020
Document Type: Informational Pages
Sponsor: Employee Benefits

Summary
Certain brand-name medications as well as compound drugs that contain certain ingredients may not be covered under the Plan. If you fill a prescription for a non-covered brand-name or compound medication you will be responsible for the full cost of the medication and that cost will not be applied to your out-of-pocket maximum. Talk with your physician about prescribing an alternative covered medication.

Drugs that are excluded under the Plan may be covered if approved in advance through a formulary exception process initiated by your physician and managed by Express Scripts, on the basis that the drug is:

1) medically necessary and essential to your health and safety and/or

2) all covered formulary drugs comparable to the excluded drug have been tried.

Please refer to the most recent Formulary below.  The Formulary is a National Preferred Formulary Exclusions List by Express Scripts; the Formulary is not specific to the City of Saint Louis Plan.
Questions about specific drugs should be consulted with Express Scripts at 866/595-7317.

Specialty Medications

SaveOnSP is the City's copay assistance benefit administrator for Specialty Drugs through Express Scripts. SaveOnSP monitors available specialty manufacturer copay assistance programs to optimize savings opportunities. The access drug list is modified from time to time. On the drug list, drugs highlighted in green are being added and drugs highlighted in red are being removed.
Please direct any questions to SaveOnSP at 800.683.1074 Monday through Thursday 8 a.m. to 11 p.m. Eastern and Friday 8 a.m. to 9 p.m. Eastern.