What You Need To Know
Prescription drugs can be costly without insurance, but paying for them is a lot easier when it’s affordable under your health care plan. The cost you’ll pay depends on the type of medication and how you get it filled.
What You Pay for Prescriptions
If you’re enrolled in a UnitedHealthcare (UHC) medical plan, your prescription drug benefits are administered by Optum Rx. Here are the highlights of your coverage.
| Feature: Prescription drugs (retail / mail) | Plan One | Plan Two | Plan Three |
|---|---|---|---|
| Tier 1: Generic | $20 / $40 | $20 / $40 | Plan pays 70% after deductible, combined with medical |
| Tier 2: Brand formulary | $55 / $110 | $55 / $110 | Plan pays 70% after deductible, combined with medical |
| Tier 3: Brand non-formulary | $85 / $170 | $85 / $170 | Plan pays 70% after deductible, combined with medical |
Maintenance Medications
If you take maintenance or long-term medication, you’re required to fill your prescription in a 90-day supply — either through OptumRx mail order or one of the 90-day network pharmacies, including many chain and local independent pharmacies.
After two 30-day fills, if you don’t refill your prescription for a 90-day supply with OptumRx mail order or at a participating network pharmacy, your medication won’t be covered under the plan.
Step Therapy for Certain Medications
You may be able to keep your prescription costs down by using lower-cost drugs. OptumRx will do all the legwork for you by:
- Identifying a lower-cost alternative medication if available.
- Contacting you and your doctor to determine if switching medications may be right for you
- Getting a new prescription from your doctor for you if it’s determined that a lower-cost drug is an option for you.
Prior Authorization and Why It’s Needed
Prior authorization is a review process where your health insurance carrier will decide if it is able to cover certain medications. Your doctor must receive the green light from your medical insurance carrier before you can fill your prescription. Prior authorization helps:
- Ensure safety. This process confirms that the medication is safe and effective for your condition. It helps prevent potential harm by identifying negative interactions with medications you’re already taking.
- Save money. Insurance companies want to make sure there’s not a less expensive option that works just as well.
- Prevent misuse. It helps prevent the misuse or overuse of certain medications, making sure they’re used properly and only when needed.
Tips for Saving on Prescriptions
Here are a few ways you can save on future prescription medications:
- Whenever possible, ask for a generic equivalent to save money, and use in-network pharmacies to avoid paying more.
- If there isn’t a generic drug option to treat your condition, ask about using a drug that’s preferred on the formulary, as these will come at a lower cost for you.
- When possible, ask your doctor for a 90-day mail order prescription. It’s the equivalent of paying for two months and receiving one month free.
- Certain preventive care drugs may bypass the deductible or may even be covered at 100% when you fill them in-network.
You can view the prescription drug list, price for your medication, and find in-network pharmacies by visiting the OptumRx website.
