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Prescription drug benefits are available to all employees and their family members that are enrolled in the State of Ohio medical plan.

Prescription Management

Filling a Prescription

Employees have two options for filling their prescriptions:
1. Employees can take their prescription to a pharmacy within the OptumRx network; or 
2. Employees can receive prescriptions by mail through OptumRx Home Delivery.

Medications Requiring Approval

Cost Comparison

Want to save some money? OptumRx offers a variety of Web-based features intended to put you in touch with valuable health and prescription drug benefit information. Through OptumRx.com, you can review your plan’s benefits, locate a participating pharmacy, view and print your prescription history, and more.

In addition, OptumRx’s online drug pricing tool, Price & Save, can save you money by comparing the price of your prescriptions at local retail pharmacies and through mail service. This allows you to shop for the most competitively priced pharmacy to obtain your prescription and helps save you money. Unlike other drug pricing tools, Price & Save identifies the lowest priced pharmacies without bias, enabling you to become a fully informed consumer.

Prescription Drug Copayment Costs

 

PRESCRIPTION DRUG COPAYMENT COSTS
  OHIO MED PPO
COPAYMENT COSTS
OHIO MED HDHP
COINSURANCE 
COSTS
TYPE OF
MEDICATION
30-DAY SUPPLY
AT RETAIL
COPAYMENT
30-DAY SUPPLY
SPECIALTY
COPAYMENT
90-DAY SUPPLY
AT RETAIL
COPAYMENT
90-DAY SUPPLY
AT MAIL-ORDER
COPAYMENT
ALL TYPES OF
MEDICATION
Generic $10 $10 $30 $25 You pay 100% until
the deductible is met, then 20% until the out-of-pocket limit is met.

Deductible amounts: $2,000 single/ $4,000 family
Preferred
Brand-Name
$35 $35 $105 $87.50
Non-Preferred
Brand-Name,
Generic
Unavailable
$60 $60 $180 $150
Non-Preferred
Brand-Name,
Generic Available
$60 plus the difference between the cost of the brand-name and generic drug $60 plus the difference between the cost of the brand-name and generic drug $60 plus the difference between the cost of the brand-name and generic drug $60 plus the difference between the cost of the brand-name and generic drug
Out-of-Pocket
Maximum*
$2,500 single/$5,000 family $3,500 single/
$7,000 family
The amount charged to the individual for generic, preferred brand and non-preferred brand medications will not be greater than the actual cost of the medication. Therefore, the amount charged may be less than the flat-dollar copay.

The maximum copay for oral oncology medications will be $100 for a 30-day supply. For more details, visit
das.ohio.gov/prescriptiondrug.

* Pharmacy copays do not apply toward the medical/behavioral health plan deductibles and the annual out-of-pocket maximum for the Ohio Med PPO.
 

 

Mail Order

OptumRx Home Delivery 
Home delivery is an important element of your care. OptumRx Home Delivery is a full-service, state-of-the-art home delivery pharmacy. It offers an easy, cost-effective and convenient way for you to fill prescriptions for maintenance medications. 

You’ll benefit from lower co-pays by refilling a 90-day supply rather than the typical 30-day supply. OptumRx Home Delivery offers convenient delivery to your specified location. 

OptumRx Home Delivery features:

  • Convenient and easy-to-use mail service delivery to anywhere in the US
  • Prompt, caring and attentive service from a team of registered pharmacists and customer service representatives
  • A quality-controlled dispensing process
  • Free shipping and delivery for most medications

Submit inquiries to OptumRx at 1-866-854-8850 or visit the OptumRx website at OptumRx.com.

Diabetes Management Program

When A Brand Name Drug Becomes Generic

What Happens When A Generic Becomes Available? 

When a brand name medication becomes available as a generic, its status is evaluated by OptumRx. In most cases, the generic medication is automatically placed at the Tier 1 copay level and the brand medication is placed in Tier 4. 

If this happens to a medication you are currently taking and you choose to continue with the brand name, you will be charged a higher copay. The Tier 4 copay is the Tier 3 copay plus the difference in cost between the brand and generic drug.

Due to the frequency of generics becoming available in the marketplace, these types of changes can occur at any time and without advance notice.

OptumRx Formulary Changes and Drug List

Formulary Changes

OptumRx Advantage Formulary Reference Guide

The OptumRx Advantage Formulary Reference Guide is a complete version of the OptumRx Formulary. However, changes may occur throughout the year and existing plan rules may override this document. Benefit designs may vary with respect to coverage, quantity limits, step therapy, and other plan design requirements. Click the buttons under “Important Prescription Updates” on this page for more information. You may also contact OptumRx Customer Service at 1-866-854-8850.

OptumRx Select Standard Formulary - July 1, 2020

OptumRx Select Standard Formulary - Jan. 1, 2020

OptumRx Select Standard Formulary - July 1, 2019

OptumRx Select Standard Formulary - Jan. 1, 2019

OptumRx Select Standard Formulary - Jan. 1, 2018

Specialty Drug List

OptumRx Website Login Instructions

1. Follow the instructions to register for the first time at OptumRx.com
2. Type your Member ID from your ID card.
3. Type your password.

To access the online drug pricing tool, click on Price & Save, located on the top of the screen, and enter your prescription information.

General Contact

Ohio Department of Administrative Services
30 E. Broad St., 27th Floor
Columbus, Ohio 43215
Local: 614-466-8857 
Toll Free: 800-409-1205, option 2

Driving Directions

Benefits Administration Services Home Page