EPAP for Pharmacies

How do pharmacies use the Emergency Prescription Assistance Program?

Before a Disaster: Enroll your pharmacy

By planning now, you can prepare to help uninsured people in your community stay healthy when disaster strikes. Pharmacies must be registered with Express Scripts to process claims under EPAP. If you are not already registered, visit the Express Scripts website to register.

Not sure if your pharmacy has enrolled? Search the list of EPAP-enrolled pharmacies to find out.

During and After a Disaster: Processing claims under EPAP

Once your pharmacy is enrolled in EPAP, you must ensure that all of the following criteria are met before providing assistance:

1. Confirm that EPAP has been activated in your patient's area: EPAP claims can only be filed for patients who live in a federally designated disaster area. Your pharmacy does not have to be located in the federally designated area in order to process a claim under EPAP. To find out whether EPAP has been activated in your patient’s area, check the EPAP Status.
2. Assist patients with eligibility and registration: EPAP coverage only extends to uninsured patients. Patients that have health insurance, such as an individual health insurance policy or employer-sponsored coverage; public insurance, such as Medicare or Medicaid; or other third party coverage, are not eligible to receive assistance under EPAP. If a patient says they are eligible but they have not confirmed their eligibility or registered with EPAP, tell them to call the EPAP Hotline at 1-855-793-7470. If they cannot call, you may call on their behalf if they are willing to provide you with the necessary information.
3. Check for a valid prescription: Eligible patients must provide ONE of the following: 1) a new, written prescription from a licensed health care practitioner; 2) a current prescription bottle; 3) a prescription phoned in or electronically transmitted by a licensed health care practitioner; or 4) proof of an existing prescription. If patients need replacement durable medical equipment (DME), medical supplies, or vaccines that do not usually require a prescription, contact the patient’s healthcare provider.
4. Ensure that the prescription and/or DME is covered under EPAP: EPAP only covers certain prescription medications and DME. To find out whether the patient’s medication and/or DME is covered, please see Items Covered by EPAP. Enrolled pharmacies must dispense the generic form of a medication unless indicated as Brand Medically Necessary (BMN) or Dispense as Written (DAW) by the licensed health care practitioner.
5. Provide a 30 day supply of prescription drugs: Patients can receive an initial 30-day supply of most prescription drugs or specific medical supplies under EPAP. Prescriptions can be renewed every 30 days for as long as EPAP is active. If patients rely on medical supplies, they can get additional supplies every 30 days for as long as EPAP is active. DME is typically only provided once, but if it is lost or stolen after it has been issued, it may be replaced. Vaccinations are typically a single course of treatment and do not need to be refilled.

Questions?

If you have questions, call Express Scripts at 800-282-2881.