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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

Medications Requiring Approval - July 1, 2019

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

2021 Formulary Changes - Jan. 1

2020 Formulary Changes - July 1

2020 Formulary Changes - Jan. 1

2019 Formulary Changes - July 1

2019 Formulary Changes - Jan. 1

2018 Formulary Changes - July 1

2018 Formulary Changes - Jan. 1

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 - Jan. 1, 2021

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