Prescription Claims
When you go to a pharmacy within Express Scripts’ network, you should only be responsible for your copay. Covered prescriptions filled at a non-network pharmacy should be filed with Express Scripts, formerly known as Medco Health Solutions, the Health Plan’s prescription benefit manager, for reimbursement.
Step 1: Fill out the Prescription Drug Claims Form.
- In the Group Number field, write in “DGA-PPHP.”
- In the Member ID field, write in the Member ID that appears on your Express Scripts prescription card.
Step 2: Be sure to include prescription receipts with your claim form.
Step 3: Submit your claim.
| By FAX | |
| (608) 741-5475 | |
| When faxing your claim, be sure to keep your fax confirmation sheet for your records.
NOTE: Please use one claim form per fax. Do not combine claims for different members in the same fax submission. |
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| By MAIL | |
| DO NOT submit claims to the Health Plan Office.
Mail your completed form and additional information to: Express Scripts |
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