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.
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.
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.
Need another form? View a list of our frequently used health care forms.