Pharmacy
Your prescription drug program is with Optum Rx, with retail, mail order and specialty prescription options.
Prescription drug coverage is automatically included when you enroll in a UMR medical plan. You don’t need to enroll in prescription drug coverage separately.
All medical plans include prescription drug coverage through Optum Rx. Your Rx information is on your medical ID card.
Understanding your prescription drug coverage
Your cost depends on the tier assigned to each drug:
- Generic (Tier 1): An affordable and effective alternative to a brand-name drug, typically the lowest-cost option.
- Preferred brand (Tier 2): Typically costs more than a generic but less than other brand-name drugs because of its preferred status, based on clinical value and cost-effectiveness.
- Non-preferred brand (Tier 3): Costs more than a preferred brand drug because of its non-preferred status.
- Specialty: Expensive drugs used to treat complex, chronic or rare medical conditions. Typically, these can only be filled by a specialty pharmacy.
Retail vs. mail order
Retail pharmacies are typically used for 30-day prescriptions. You may be able to order a 90-day supply of maintenance medications at a retail pharmacy or through mail order. The advantage of mail order is convenience — your prescription is delivered to your door with an auto-refill option.
Compare coverage details
Prescriptions are covered only at in-network pharmacies. Out-of-network pharmacies are not covered. For more coverage details, view the Summary Plan Description for each plan on the Documents & Forms page.
Your cost is determined by the tier assigned to the prescription drug. Medical and pharmacy expenses count toward the same deductible.
Note about PPO plans: The deductible does not apply to prescription drugs, except fertility care medications.
| HDHP | PPO 2750 & PPO 6000 | |
|---|---|---|
| Retail (30-day supply) Tier 1: Generic |
You pay 20% after deductible | $10 copay |
| Retail (30-day supply) Tier 2: Preferred brand |
You pay 20% after deductible | $40 copay |
| Retail (30-day supply) Tier 3: Non-preferred brand |
You pay 20% after deductible | $80 copay |
| Mail order (90-day supply) Tier 1: Generic |
You pay 20% after deductible | $25 copay |
| Mail order (90-day supply) Tier 2: Preferred brand |
You pay 20% after deductible | $100 copay |
| Mail order (90-day supply) Tier 3: Non-preferred brand |
You pay 20% after deductible | $200 copay |
| Specialty (30-day supply through Optum Specialty) Tiers 1, 2 and 3 |
You pay 20% after deductible | $275 copay |
Fertility Care
There is a $10,000 lifetime maximum benefit for pharmacy fertility care treatments.
- HDHP: You pay 20% after the deductible
- PPO 2750: You pay 25% after the deductible
- PPO 6000: You pay $0 after the deductible
Manage your prescriptions online
Go to Optum Rx online to manage your prescriptions, schedule and track medication deliveries, and talk to a pharmacist, all in one place. Log in with your HealthSafe ID. If you don’t have one yet, you can register using the information on your ID card.
RxManage
With RxManage, you can order brand-name medications and have them delivered to your home, with automatic refills so you never run out. To learn more and see if you qualify for savings on expensive brand medications, call your Clinical Advocate at 1-800-876-9835.
Pharmacy savings
GoodRx and RxSaver let you compare prescription drug prices and find possible discounts. If you use these tools, check the price against the cost through your insurance to get the best deal.
These discounts can’t be combined with your benefit plan’s coverage. If you use a discount card from GoodRx or RxSaver, the amount you pay will not count toward your deductible or out-of-pocket maximum.
Find in-network pharmacies
Visit the Optum Rx website or call 855-524-0381 to find in-network pharmacies near you.
Your Contacts
Prescription drug coverage
855-524-0381