Pharmacy and prescription drug benefits
Prescription drugs can play an important role in your health, whether you need them every day or once in a while. Knowing how your benefits work may help you fill your prescriptions more easily and help manage costs. Let’s walk through how to use your pharmacy and prescription drug benefits.
Tips for using your pharmacy benefit
Ask about lower cost options
If a prescribed medication is in a higher cost tier, ask your doctor if a lower cost option will work for you. A similar drug or generic version can often work just as well.
See if you need prior authorization
Some medications need prior authorization. This means your doctor must explain why you need the drug. Then your plan decides how or if they will cover it. To start the prior authorization process, call the number on your member ID card.
Review your PDL regularly
Keep in mind that PDLs may change. If you have prescriptions you take regularly, watch for notifications about PDL updates and possible cost changes.
Look for ways to save
If you’re a UnitedHealthcare member, there are pharmacy programs that may be available to help you save on costs.
View pharmacy information for specific plans
Want to shop over-the-counter (OTC) products?
Visit Optum Now and shop for nonprescription medications, everyday essentials and more.
How to fill your prescriptions
With some plans, you can fill your prescriptions at a participating network pharmacy or with home delivery.
Find a network pharmacy
Choosing a network pharmacy may help you save on medication costs. Sign in to your member account to view a list of pharmacies included in your plan’s network.
Set up home delivery
Plans that include home delivery help you avoid regular trips to the pharmacy and may save you money. You can enroll through your online account or by calling the number on your member ID card.
What is Optum Rx?
You may see the name Optum Rx on your prescription benefits. This is the UnitedHealthcare pharmacy service provider. Optum Rx offers coverage through a large network of retail chain pharmacies and independent pharmacies. It also offers coverage through its mail order pharmacy, Optum Home Delivery®.
Frequently asked questions
You can search the Optum Rx pharmacy network to view network pharmacy locations. Before filling a prescription, make sure to confirm your plan’s specific coverage details. Sign in to your member account to view your prescription benefit details. You can also view plan details in the UnitedHealthcare app.
Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your benefit plan. This is how much you pay when you fill a prescription. Your plan’s Prescription Drug List (PDL) gives you choices so you and your doctor can determine the best course of treatment. Using lower-tier medications can help you pay lower out-of-pocket costs. Below is an example of a 3-tier plan — your plan may have a different number of tiers.
| Drug tier | Prescription | Cost |
|---|---|---|
| Tier 1 | Medications that provide the highest overall value. Mostly generic drugs. Some brand name drugs may be included. |
$ |
| Tier 2 | Medications that provide good overall value. Mainly preferred brand-name drugs. |
$$ |
| Tier 3 | Medications that provide the lowest overall value. Many Tier 3 drugs have lower-cost options in Tiers 1 or 2. Ask your doctor if they could work for you. |
$$$ |
You can fill prescriptions at any network pharmacy. If you’re traveling and away from your home pharmacy, find your closest network pharmacy and call the pharmacy to fill your prescription.
Review your plan’s Prescription Drug List (PDL), also called a formulary. The PDL is a list of medications that shows how they’re covered by your plan. If you have a prescription, you can look it up in your PDL to see how it’s covered and how much it costs.
Your doctor can start the prior authorization process. Or you can call the number on your member ID card and Optum Rx® will contact your doctor.
- If you're new to Optum Specialty Pharmacy and want to begin filling your prescriptions, start your fill.
- If you’re a current patient, sign in and request a prescription refill. Once Optum Specialty Pharmacy receives your request, their pharmacy team will work with you and your doctor's office to fill your prescription and provide support and education.
Optum Specialty Pharmacy offers convenient delivery of medications directly to you. They use experienced carriers to help ensure your medications are carefully shipped. If your medications require special handling or refrigeration, they will be packed and shipped accordingly. There is no cost for standard shipping or handling.