If you’re enrolled in the Student Health Plan (SHP), your prescriptions are covered automatically through OptumRx. For information about your prescription benefits, contact OptumRx Member Services online or by calling 1-877-615-6319.
Paying for Prescriptions
You will pay for your prescriptions with a copayment that is determined by the formulary and whether you use a retail pharmacy or the lower cost mail order program. A formulary is a list of prescribed medications that have proven to be both clinically and cost effective. Prescriptions on the formulary are categorized into three tiers – generic, preferred brand, and non-preferred brand – and those tiers determine your cost for a medication. There are preferred products in every therapeutic class in the formulary. See the OptumRx Formulary Reference Guide (.pdf) to review the cost for your prescription.
Prescription Costs
|
Prescription Drug Benefit Retail: 30-day supply |
Mail Order Drug Benefit 90-day supply |
Specialty Pharmacy Benefit* Optum Specialty Pharmacy |
|---|---|---|
|
$5 Generic (Tier 1) $20 Preferred Brand (Tier 2) $70 Non-Preferred Brand (Tier 3) |
$10 Generic (Tier 1) $40 Preferred Brand (Tier 2) $140 Non-Preferred Brand (Tier 3) |
$5 Generic (Tier 1) $20 Preferred Brand (Tier 2) $70 Non-Preferred Brand (Tier 3) |
*Some specialty medications are not covered at a retail pharmacy and may be purchased only through OptumRx Specialty Pharmacy. To enroll or learn more, call (855) 427-4682 or visit their website.
| Individual | Family | |
|---|---|---|
| Deductible | $100 | $200 |
| Out of Pocket Maximum | $1,350 | $2,700 |
| Lifetime Infertility Maximum | $20,000 | --- |
Preventive Medications
Some prescriptions, classified as preventive, are eligible for coverage without copayment. Learn about which prescriptions are considered preventive (.pdf).
Purchases at Retail Pharmacies
If you need to purchase a prescription at a participating retail pharmacy before you receive your ID card, you can contact OptumRx. Your pharmacy will need the following information to process your prescription:
- RxBIN: 610011
- PCN: IRX
- RxGROUP: PURPRNCST
- Member ID: (call 1-877-615-6319 to obtain)
Mail Order Purchases
To have your prescriptions delivered via mail, complete the OptumRx Mail Order (.pdf) form. This form cannot be sent via fax.
Prior Authorization
Some prescriptions require prior authorization from your prescribing physician for clinical exceptions through OptumRx (e.g., if you are taking a non-preferred or excluded medication due to an allergic reaction to the preferred brand equivalent). If the prior authorization is approved, you will only be responsible to pay the preferred brand copay.
For students outside the U.S. needing to fill a prescription on or after January 1, you will need to pay out of pocket for the medication and then submit a OptumRx Reimbursement Drug Claim form (.pdf) to OptumRx for reimbursement.
Mobile App
Through the OptumRx mobile app, you can access your electronic pharmacy ID card; you will need your member ID to register. Get the mobile app by searching for OptumRx at the Apple App StoreSM or Google Play™.