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 - August 2015

Medications Requiring Approval - August 2014

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

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 our team of registered pharmacists and customer service representatives;
• A quality-controlled dispensing process; and
• 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

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.

2019 Formulary Changes - Jan. 1

2018 Formulary Changes - July 1

2018 Formulary Changes - Jan. 1

2017 Formulary Changes - July 1

2017 Formulary Changes - Jan. 1

2016 Formulary Changes - Jan. 1

2015 Formulary Changes - July 1

2015 Formulary Changes - April 1

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 - Jan. 1, 2019

OptumRx Select Standard Formulary - Jan. 1, 2018

OptumRx Select Standard Formulary - July 1, 2017

OptumRx Select Standard Formulary - Jan. 1, 2017

2016 OptumRx Advantage Formulary Reference Guide

The Preferred Drug List is a condensed version of the OptumRx Formulary. This is not an all-inclusive list. Changes may occur throughout the year and plan exclusions may override this list. Benefit designs may vary with respect to drug coverage, quantity limits, step therapy, day supply and prior authorization.

2016 Preferred Drug List - Updated Jan. 1, 2016

2015 Preferred Drug List - Updated Jan. 1, 2015

2019 Specialty Drug List

2018 Specialty Drug List

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.

Utilization Management Program Updates effective Jan. 1, 2019

Prescription Drug Program Updates effective July 1, 2018

Utilization Management Program Update effective July 1, 2018

Clinical Program Updates effective July 1, 2018

Utilization Management Program Updates - Jan. 1, 2018

Step therapy and prior authorization updates for Jan. 1, 2018

Authorized Generic Program effective July 1, 2017

The out-of-pocket maximums for pharmacy benefits will be $2,500 for single and $5,000 for family.

Utilization Management Program Changes for July 1, 2016

Step therapy and prior authorization updates for Jan. 1

Compound Medication Summary Letter

Compounding Pharmacy Notification Letter

Compounding Pharmacy Locator Guide

• Information for Ohio members is on Page 40 of the guide. 

Diabetes Management Program Summary

Accu-Chek Product Letter

Acid Reflux/Ulcer Medication Program

Acne Agents Letter

Actos Alternatives Letter

ADHD Prior Authorization Letter

Smoking Cessation Products

Step Therapy Requirements for Anti-viral Medications