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How to File a Prescription Drug Claim

Prescription drug claims are processed by Express Scripts and should be submitted to:

Express Scripts, Attn: Commercial Claims, P.O. Box 14711 Lexington, KY 40512-4711


To process a prescription drug claim, Express Scripts requires a prescription receipt/label which includes:

• Pharmacy Name/Address

• Date Filled

• Drug Name, Strength and NDC

• Rx Number

• Quantity​

• Days’ Supply

• Price

• Patient’s Name


Claims received missing any of the above information may be returned or payment may be denied or delayed. Cash register receipts and canceled checks are not acceptable proof of your claim. If you have other insurance which is primary, you need to submit an Explanation of Benefits (EOB) from the other insurance which shows the amount the primary insurance paid with​ each claim, or ask your provider to do so if the claim is being submitted for you. You have six (6) months from the date of services to file a prescription claim. If PEIA is your secondary insurer, you have six (6) months from the date of your primary insurer’s Explanation of Benefits processing date to file your claim with PEIA. If you do not submit claims within this period, they will not be paid.

If your claim is for an illness or injury wrongfully or negligently caused by someone else, and you expect to be reimbursed by another party or insurance plan, you must file a claim with PEIA within six (6) months of the date of service to ensure that the covered services will be paid. Later, if you receive payment for the expenses, you will have to repay the amount you receive from PEIA. See “Subrogation” on page 124 for details. 

Filing Claims for Court-ordered Dependents (COD)
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If you are the custodial parent of a child who is covered under the other parent’s PEIA plan as a result of a court order, you must use your I.D. card at a participating pharmacy to receive prescription benefits.

Claims Incurred Outside of the U.S.A.

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If you or a covered dependent incur prescription drug expenses while outside the United States, you will be required to pay the provider yourself. Request an itemized bill containing all the information listed above from your provider and submit the bill along with a claim form to Express Scripts. Express Scripts will determine, through a local banking institution, the currency exchange rate and you will be reimbursed according to the terms of PEIA PPB Plans A, B & D.