If your client's health plan includes pharmacy benefits, he/she has prescription drug coverage from network pharmacies and mail order.*
Copayments are based on levels called a prescription tier. The costs are lower on tiers 1 and 2, and higher on tier 3 or tier 4, if applicable. View our prescription drug lists in PDF format.
OptumRx, our online pharmacy benefit manager, has some great tools. When health plan members register on OptumRx, they can view their medication history and copays, find a network pharmacy, see how much medications will cost, and if there are any restrictions.
Mail order pharmacy
Health plan members can use our contracted mail order pharmacy* to save time and money. They can fill out an order form and mail it (along with their prescription and the applicable copayment) to OptumRx, PO Box 2975, Mission, KS, 66201.
Providers should write members a prescription for a 90-day supply with refills when appropriate (not a 30-day supply with three refills).
If a member needs further assistance, they can fill out Section 1 of the OptumRx fax
order form. Then ask his/her provider to fill out Section 2 and fax the form for him/her.
*Mail order benefits are only available to group health plan members. Individual health plan members can go to their local pharmacy to fill their prescriptions for up to 30 days at a time. This doesn’t affect any high-cost specialty drugs members receive through the mail from BriovaRx.
A health plan member may be required to try step therapy. This means he/she must try certain drugs to treat his/her medical condition before we’ll cover another drug for that condition. He/she may submit an exception request to waive step therapy requirements or quantity limit restrictions.