How do I find out if the drug my doctor prescribed is covered by our plan?
A formulary is a list of the drugs OptumRx has selected as the preferred medication(s) in each drug class based on their safety, efficacy, and cost. A drug can be placed on one of three tiers:
Tier 1 = Generic Preferred
Tier 2 = Brand Name Preferred
Tier 3 = Non-Preferred
Non-preferred drugs are still eligible for partial coverage under the plan. A drug that is excluded is not eligible for any plan coverage. Talk with your prescriber about covered alternatives for excluded drugs to avoid paying full retail price.
A formulary can be updated at any time, especially as new drugs are introduced to the market and generic equivalents become available for brand-name drugs. This can affect your share of the cost. You can search OptumRx’s online formulary when you log into the secure member website. You can also call to speak with OptumRx member services representatives 24 hours a day at 866.854.2945 (TTY 711).
Why should I consider talking with my doctor about the possibility of taking a generic drug?
Generic medications are FDA-approved drugs that contain the identical active ingredient in the same strength as the brand-name drug. Generic drugs must meet the same standards for safety, purity, potency and quality as the branded drug, but are priced, on average, about 80% lower than the brand-name product. To encourage the use of generics, if a generic is available and you or your doctor choose to get the brand name drug (by checking the “Dispense as Written” box on the prescription), you will pay the generic copay plus the difference between the brand name drug cost and the generic drug cost.
Why may I want to consider using OptumRx Home Delivery, rather than my local pharmacy?
If you take certain medications on a daily basis, you may wish to fill those prescriptions using home delivery, which offers convenient mail order service with free standard shipping. Enroll in home delivery on the OptumRx secure member website. Orders are generally received within 14 days.
When you use home delivery, the mail-order cost sharing applies, which may result in savings if you are taking a preferred or non-preferred drug. Savings vary for each medication and savings are not guaranteed.
Use the OptumRx Home Delivery Order Form [PDF] to mail in prescriptions and payment to OptumRx. Your health care provider can also e-prescribe or fax prescriptions on your behalf.
NOTE: You can fill up to a 90-day supply of medication either at a retail pharmacy or through OptumRx Home Delivery. When you use home delivery, the mail-order cost sharing applies, which may result in significant savings over your cost at a retail pharmacy. Savings vary for each medication and savings are not guaranteed. Use the Price and Save tool on optumrx.com, or call OptumRx Member Services at 866.854.2945 (TTY: 711), to determine which method is best for each drug you take.
What do I need to be aware of if my doctor prescribes a specialty drug to me?
Specialty medications are those that treat serious chronic conditions, such as Crohn’s disease, rheumatoid arthritis, and multiple sclerosis. Specialty medications often require special handling or refrigeration, and may be self-injected rather than taken orally. You will need to obtain your specialty drugs through BriovaRx, which is a mail-order pharmacy focused on providing you with the best possible care while you receive treatment with a specialty medication. Please contact BriovaRx at 855.427.4682 (TTY: 800.735.2922) to set up your account and coordinate delivery of your medication.