Explore Your Coverage
Understanding Your Formulary
Discover the medications covered under your pharmacy benefit plan with InScript's comprehensive formulary. Click below to learn about formulary tiers, which will ensure you're informed about your plan design and medication options.
View FormularySave On Your Prescriptions
Beth Israel Lahey Health is Your Preferred Pharmacy Partner
If you are a InScript plan member, then BILH pharmacy is our preferred pharmacy. Please note that for specialty prescriptions and any prescriptions greater than a 30-day supply will be required to be filled at BILH pharmacy. Transfer your prescriptions today. For refills, simply call BILH pharmacy at (781) 352-6500 directly.
Request TransferFind Your In-Network Pharmacies
Giving Patients Wider Pharmacy Network Access
Expand your options with access to our broad network of pharmacies. Click below to use our pharmacy lookup tool and find a convenient location near you. If you are a InScript plan member, copays may be greater at non-BILH pharmacies.
Search PharmaciesDownloadable Forms and Resources
All the Information at Your Fingertips
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Plan Resources
Please visit the BILH Benefits Central website to learn more about your prescription benefits.
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Covered Drugs Requiring Prior Authorization
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Prior Authorization Forms
A prior authorization (PA) is a clinical program to ensure safety and medical necessity. If you are prescribed a drug that requires a PA, please have your provider fill out the general PA form.
As part of the InscriptRx program, weight loss GLP-1s are required to follow certain clinical criteria. If you are prescribed a GLP-1 for any indication, please have your provider use this form to submit a PA for a product.
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Specialty Medication Copay Assistance Program
The BILH Copay Assistance Program helps reduce out-of pocket costs incurred by members of our employer-sponsored health insurance plans for certain high-cost medications, called “specialty medications”. You and/or your covered dependents will be contacted if you take a qualifying specialty medication. You can also call 617-589-1162 to confirm if your specialty medication is eligible for financial support through the program.
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Direct Member Reimbursement Form
If you have forgotten your InScript ID card and paid out-of-pocket for your prescription, you may be able to be reimbursed by filling out this form. Please note that your medication must be covered and filled at an appropriate in-network pharmacy.
Easily access and download the resources you need for your pharmacy benefits. From detailed plan design information and prior authorization forms to our copay program and direct member reimbursement forms, everything is just a click away for your convenience.
OPTIMIZE YOUR CARE
Explore Clinical Programs
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GLP1 Program
Impacted Medications:
- Bydureon
- Byetta
- Mounjaro
- Ozempic
- Rybelsus
- Saxenda
- Soliqua
- Trulicity
- Victoza
- Wegovy
- Zepbound
Your BILH health plan administered by InscriptRx has adopted unique coverage criteria for glucagon-like peptide-1 (GLP-1) medications. Plan members using GLP-1s for weight loss specifically are required to complete a Medication Therapy Management (MTM) virtual visit with the BILH Weight Loss Management Clinic.
To assist with this process, the BILH Weight Management Team will call to schedule an appointment or they can be reached at 781-352-6551 to answer questions or to proactively schedule your visit.
What to expect during an MTM appointment: A weight loss-specialized pharmacist will assess and evaluate your clinical condition, review any side effects, answer any questions you have about your medications, and discuss lifestyle modifications to enhance your outcomes.
For all indications for GLP-1s, please use this form to submit a prior authorization for the product.
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Medication Therapy Management (MTM) Program
As part of the InScript clinical program, members on highly complex medications may be required to adhere to InScript’s Medication Therapy Management (MTM) program. The MTM program is a pharmacist led program to optimize therapeutic outcomes, clinical quality, and ensure medical appropriateness. When your prescription requires you to participate in the MTM program, you will be contacted by the InScript Member Services team.
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Site of Care Management Program
As part of the InScript clinical program, members on highly complex medications may be required to adhere to InScript’s Site of Care Management program. The Site of Care Management program ensures that you are being clinically managed by the appropriate medical provider to ensure the most optimal clinical outcome. If this program is required for prescription coverage, you will need to obtain a second opinion from our network approved provider. When your prescription requires you to participate in the Site of Care Management program, you will be contacted by the InScript Member Services team.
Dive into our clinical programs designed to enhance your care management. Discover more about GLP1s, Medication Therapy Management (MTM), and Site of Care Management uniquely prepared to support you.
FAQs for Patients
You’ve Got Questions, We’ve Got Answers
Find answers to your most pressing questions about InScript's Pharmacy Benefit Management. From lost ID cards to understanding your benefits, we're here to help!
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What medications are covered under my plan?
There are a few ways to check if a medication is covered under your plan:
1. Click here to view a full list of covered medications here: Formulary.
2. Log into your profile using the “Patient Login” link. Once logged in, click into the “Find Drug Info…” search bar and type in your drug. You’ll be prompted to fill in other information related to your prescription, then hit “Submit”. The results will show if the drug itself is covered, in addition to whether the brand or generic of that medication is as well.
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How can I find a network pharmacy?
BILH pharmacy is our preferred pharmacy. Please note that filling at non-BILH pharmacies may result in greater copays and that specialty and prescriptions with greater than a 30-day supply will be required to be filled at BILH pharmacy.
To see a full list of in-network pharmacies near you, use our pharmacy lookup tool here: Pharmacy Lookup Tool.
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Are there any limitations to where I can fill my prescriptions?
BILH pharmacy is our preferred pharmacy. For 30-day prescriptions, your medications can be filled at any in-network pharmacies. For any prescriptions over a 30-day supply and specialty drugs, these will have to be filled exclusively at BILH pharmacy. With 6 different locations, you can find a convenient location near you or opt to have your medications delivered directly to your home.
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How do I transfer my prescription to a network pharmacy?
Fill out the transfer request form to minimize your prescription costs: Request Transfer.
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What is the copay for my medication?
Log into your profile using the “Patient Login” link. Once logged in, click into the “Find Drug Info…” search bar and type in your drug. You’ll be prompted to fill in other information related to your prescription, then hit “Submit”. Scroll down to see prices at surrounding in-network pharmacies as well as safety and storage information for the drug itself. Please note that these pricings are estimates and may not reflect actual pricing. Be sure to check with your pharmacy.
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Can I get my medication delivered?
Yes! In fact, we encourage it. Exclusive to BILH pharmacies, click here to fill out the form to get your medications sent directly to your home: Request Transfer.
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Will I need to get a new PA when transitioning to InScript?
If you have an active authorization with CVS, you will not need a new one as they will be transferred over to us.
**Please note that some prior authorization not provided by CVS Caremark will not be available to InScript and will need a new prior-authorization.
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What is a prior authorization (PA) and how do they work?
A prior authorization is a clinical program put in place for the prescription to be covered by your plan based on many reasons, such as safety and medical necessity. When this is required, the physician ordering the prescription must give reasons why they believe the medication is right for you. The health plan evaluates the information and decides whether you meet the criteria to safely receive the drug.
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How can I see what my benefits are?
There are a few ways to check your benefits:
1. Click here to access your benefit summary document: Benefits.
2. Log into your profile using the “Patient Login” link. Once logged in, click on the “Coverage & Benefits” module.” -
Did you lose your member ID card?
No problem! Log into your profile using the “Patient Login” link. Once logged in, go into the “Coverage & Benefits” module. You will find your member information there along with the ability to print an ID card or request a replacement card.
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What is direct member reimbursement and how do I file a claim for reimbursement?
If there is a situation where you may have lost or forgotten your card and had your prescription filled at an in-network pharmacy, you may be eligible for reimbursement of the cost you paid.
To find out, click here to fill out the direct member reimbursement form to submit for review: DMR Form.
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What is the difference between an out-of-pocket maximum versus a deductible?
Out-of-Pocket Maximum
An out-of-pocket maximum is the maximum amount you can be subject to pay for your pharmacy benefit plan in a plan year. Copayments paid towards your prescription medication contribute to your out-of-pocket maximum. After you reach the maximum defined by your pharmacy benefit plan, the plan will pay 100% for any covered service, and you will not have to pay any additional money out of pocket.
Example: If your out-of-pocket maximum is $3,000 on your pharmacy benefit plan, you can be subject to pay up to $3,000 for services and prescriptions through your copayment. Once you spend $3,000, the pharmacy benefit offered by your pharmacy benefit plan will cover any extra services, prescriptions, and costs for the rest of the year.
Deductible
A deductible is the amount you must pay out of pocket for services before the pharmacy benefit plan starts to pay.
Example: If your pharmacy benefit plan has a $1,500 deductible, you must pay the first $1,500 out of pocket before the pharmacy benefit plan starts covering any costs. Depending on the plan design, you may still have to pay copay amounts for additional services.
Contact Us
Quality Customer Service You Deserve
Our Member Help Desk is here to support you with any questions or concerns.
Contact UsReach out to us at (855) 542-1819 for dedicated assistance from our knowledgeable customer service team.
For mail-order pharmacy contact:
[email protected]
For specialty pharmacy contact:
[email protected]
