If your patient’s health plan includes pharmacy benefits, he/she has prescription drug coverage from network pharmacies and mail order.*
Copayments are based on levels called a prescription tier. The costs are lower on tiers 1 and 2, and higher on tier 3 or tier 4, if applicable. View our prescription drug lists in PDF format.
OptumRx, our online pharmacy benefit manager, has some great tools. When members register on OptumRx, they can view their medication history and copays, find a network pharmacy, see how much medications will cost, and if there are any restrictions.
Mail order pharmacy
Health plan members can use our contracted mail order pharmacy* to save time and money. He/she should fill out Section 1 of the OptumRx fax order form. Then you can fill out Section 2 and fax it to 1-800-491-7997.
Please write your patient (the health plan member) a prescription for a 90-day supply with refills when appropriate (not a 30-day supply with three refills).
To refill a prescription, please call 1-800-788-4863.
*Mail order benefits are only available to group health plan members. Individual health plan members can go to their local pharmacy to fill their prescriptions for up to 30 days at a time. This doesn’t affect any high-cost specialty drugs members receive through the mail from BriovaRx.
Prior Authorization/Step therapy
A health plan member may be required to try step therapy. You may help him/her fill out and submit a Pharmacy Medical Necessity Request Form to waive step therapy requirements or quantity limit restrictions.
