Using your pharmacy benefit
Your pharmacy benefit services OptumRx is your plan s pharmacy services manager and is committed to helping you find cost-effective ways to get your medication(s). Set up your online account Once registered on our website, access the online pharmacy section through the Pharmacies & Prescriptions tab to: Manage your home delivery medications. Set up email or text message 1 reminders. Check your order status. Use a network pharmacy Be sure to fill your prescriptions at a network pharmacy, otherwise they may not be covered or you may pay more 2. Finding a network pharmacy is easy: Log in to the website on your health plan ID card. Or call the toll-free phone number on the back of your health plan ID card. TTY users can dial 711. 1 OptumRx provides this service at no additional cost to you. Standard message and data rates charged by your carrier may apply. 2 In New York, prescriptions filled at an out-of-network pharmacy may not be covered. In New Jersey, you may need to pay more for prescriptions filled at an out-of-network pharmacy. Need more information? Visit the website on your health plan ID card to learn more. 2
Home delivery from OptumRx Use OptumRx home delivery to help manage the medications you take regularly. Home delivery is safe, reliable and offers the following advantages: Convenience Get standard shipping at no additional cost on medications delivered to your mailbox. 24/7 access and reminders Speak to a pharmacist who can answer questions any time, any day. Even set up text and email reminders to help you remember to take or refill your medications. Make the choice to use home delivery By going online: Visit the online pharmacy through the Pharmacies & Prescriptions section on to the website on your health plan ID card, register and follow the simple step-by-step instructions. By phone: Call the toll-free member phone number on the back of your health plan ID card. TTY users can dial 711. It s helpful to have your ID card and medication bottle(s) available. By eprescribe: Ask your doctor to send an electronic prescription. If you need your medication right away, ask your doctor for a one-month prescription to fill at a local pharmacy and a three-month prescription you can use to set up home delivery. Log on to the website on your health plan ID card to start using home delivery. 3
Making medication decisions Use the Prescription Drug List (PDL) The PDL is a list of your plan s covered medications. The medications are organized into cost tiers. Choosing medications in lower tiers may help you save money. Cost tier Includes Helpful tips $ Tier 1 Lowest cost $$ Tier 2 Mid-range cost $$$ Tier 3 Highest cost Lower-cost medications. Some brand-name medications. Mix of brand-name and generic medications. Highest cost brand-name medications and some generic medications. Tier 1 medications have the lowest out-of-pocket costs. Consider generic alternatives. Tier 2 drugs may cost less than Tier 3 drugs 3. Many Tier 3 medications have lower-cost options in Tiers 1 or 2. Ask your doctor if they could work for you 3. Some Connecticut plans have a fourth tier that includes higher cost brandname and generic medications, as well as non-preferred brand-name and specialty medications. Save money Generic medications may have a lower co-pay than brand-name medications. Ask your doctor if there is a generic alternative for you. Compare prices Search for lower-cost alternatives. Just log in to the online pharmacy through the Pharmacies & Prescriptions section of the website on your health plan ID card, and follow the instructions. 3 Generic medications in Tiers 2 and 3 will not exceed $25 for a 30-day supply. Need more information? Visit the Pharmacies & Prescriptions section on the website listed on your health plan ID card to learn more. 4
Tips Know your plan Your plan may require one or more of the following for your prescription to be covered: Prior authorization approval to get a medication. Step therapy (First Start) trying one medication before another. Quantity limits only a certain amount of the medication is allowed with your co-pay or in a specific time period. All of these items are subject to medical review and appeal. Check your Prescription Drug List (PDL) Your PDL is a list of covered medications. The list is broken into sections called tiers. Choosing medications in lower tiers may save you money. Check your PDL often. Talk to your doctor When you talk with your doctor, use the PDL to confirm coverage and costs. You can also talk about what you need to do to get your medication. Log on to the website on your health plan ID card and check the Pharmacies & Prescriptions section to see if you could save. 5
Your plan may also include Mail Service Member Select If you re a member of a self-funded plan, your plan may include Mail Service Member Select, which allows you a limited number of refills at your current pharmacy. After that, you ll have to take action. Program name Mail Service Member Select Action needed: Enroll in home delivery by logging into the website on your health plan ID card. Select Online Pharmacy in the Pharmacies & Prescriptions section and log onto OptumRx. Then, click Get Started. Or, call 1-800-444-6222. TTY users can dial 711. OR Disenroll from the Mail Service Member Select program and continue filling your prescription at a retail pharmacy for your standard co-payment or cost-share by logging into your member website (listed on your health plan ID card). Then, choose which medications you want to remove from Mail Service Member Select. Or, call 1-800-444-6222. TTY users can dial 711. Need more information? Visit the Pharmacies & Prescriptions section on the website listed on your health plan ID card to learn more. 6
Hassle-Free SM Fill The Hassle-Free Fill program provides automatic refills for eligible maintenance medication if you use home delivery and choose to participate. When it s time to refill, OptumRx will automatically: Call to let you know that your medication will ship soon (unless you cancel it within three business days of the refill notice). Bill your credit card for any copay, coinsurance or amount due. You can call the number on the back of your member ID card or sign in to your online account to start using Hassle-Free Fill. Just log in to the website on your health plan ID card, go to the Pharmacies & Prescription and choose which home delivery medications you would like automatically refilled. BriovaRx, the OptumRx specialty pharmacy You may be able to use BriovaRx, the OptumRx specialty pharmacy. BriovaRx is more than just a way for you to get your specialty medications. It provides ongoing support to help you manage more complicated conditions. Log on to the website on your health plan ID card and check the Pharmacies & Prescriptions section to see if you could save. 7
Visit your member website to get the most out of your pharmacy benefit. If you have any questions, please call us at the toll-free phone number on your health plan ID card or 1-800-444-6222, Monday through Friday, 8 a.m. to 6 p.m. ET. TTY users can dial 711. The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. We provide free services to help you communicate with us. Such as letters in other languages or large print. You can also ask for an interpreter. To ask for help, please call the toll-free phone number listed on your health plan ID card Monday through Friday, 8 a.m. to 6 p.m. TTY users can dial 711. ATENCIÓN: Si habla español, hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al número de teléfono gratuito que aparece en su tarjeta de identificación. 請注意 : 如果您說中文, 我們免費為您提供語言協助服務. 請撥打會員卡所列的免付費會員電話號碼. OptumRx, Inc. is an affiliate of UnitedHealthcare Insurance Company. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Administrative services provided by Oxford Health Plans LLC. 9696 R8 08/2017Consumer 2016 Oxford Health Plans LLC. All rights reserved. 67937-082017 MT1111769 16-3503 MS-16-571