If your plan includes pharmacy benefits, you have prescription drug coverage from network pharmacies. Some HPN plans may not include CVS and Walmart in their pharmacy network.
Your copay is based on levels called a prescription tier. The costs are lower on tier 1 and higher on tier 3, or tier 4 if applicable.
More flexibility. More convenience. Lower cost. Your health plan now covers a 90-day supply of medication through local Walgreens pharmacies. With a 90-day supply, you won’t need to get a refill every month.
Medications eligible for the 90-day refill option usually require regular, daily use and/or are commonly used to treat chronic or long-term conditions including high blood pressure, heart disease, asthma and diabetes.
Providing members with 90-day prescriptions may lead to:
To find out what medications are included, call Member Services at the number on the back of your health plan ID card.
*Most members will save ½ a copay when they fill brand name and higher priced generic medications. Most lower priced generic medications will already pay at a rate less than a member’s copay amount so savings may not be as substantial.
Mail order benefits are available to group and individual health plan members. Orders for a new prescription should arrive within 10 business days. Refills should arrive in about seven business days. There’s no cost for standard delivery to U.S. addresses, including U.S. territories.
Orders for a new prescription should arrive within 10 business days. Refills should arrive in about seven business days. There’s no cost for standard delivery to U.S. addresses, including U.S. territories.
Members may qualify for up to 50% off one month’s copay for each prescription filled through OptumRx. Pharmacists are available by phone to answer your questions 24/7.
Your provider should write your prescription for a 90-day supply with three refills when appropriate (not a 30-day supply). To refill a prescription, please call toll-free 1-800-788-4863, TTY 711, or set up an account at OptumRx.com.
Compound pharmacies prepare customized medications – under the direction of your doctor’s prescription – specific to your medical needs. When the formulation of a medication doesn’t work for you, compounding pharmacies may allow you to overcome these barriers. Ask your doctor if this option is right for you.
Specialty pharmacies provide medications used to treat rare or complex health problems. These medications are usually expensive and require special handling. They can be taken by mouth, injected, inhaled or infused. Specialty drugs are labeled on your plan’s drug list with the abbreviation “SP.” Coverage of specialty medication is limited to a 30-day supply.
For any questions related to your specialty medications, account issues, or prescription notification preferences, please call toll-free 1-855-427-4682, TTY 711. For statement questions or to pay your bill, call 1-855-577-6521.