Prescription Drug Program

Employee Only: $2,000 (Participants must pay the full annual deductible before the UVA Health Plan begins to pay for any covered prescription costs.)

Family*: $4,000 (Participants must pay the full annual deductible before the UVA Health Plan begins to pay for any covered prescription costs.)

*Those with Employee + Children, Employee + Spouse, and Family coverage have the family deductible.

For Prescriptions: $100 per person for covered tier 2 and tier 3 retail drugs

For Prescriptions: $100 (does not apply to mail-order prescriptions)

Employee Only: $6,000 (Participants must pay the full annual deductible before the UVA Health Plan begins to pay for any covered prescription costs.)  

Family*: $12,000 (Participants must pay the full annual deductible before the UVA Health Plan begins to pay for any covered prescription costs.)  

*Those with Employee + Children, Employee + Spouse, and Family coverage have the family deductible.

For Prescriptions: $100 per person for in-network allowable charges of covered tier 2 and tier 3 retail drugs

For Prescriptions: $100 per person for in-network allowable charges of covered tier 2 and tier 3 retail drugs

The first time you use the OptumRX website, you will need register..

• Go to www.optumrx.com and click on “Register now”.
• Follow the prompts to register. You will need your Member ID number (found on your OptumRx card), so have your card handy.
• Begin using the OptumRx site.

When you first sign up for the UVA Health Plan, or switch between options, you will receive an OptumRx card by mail. The OptumRx pharmacy card is separate from your Aetna UVA Health Plan medical insurance card.

To view or print a temporary card, use the following steps:

• Go to www.optumrx.com, enter your username and password, and click “Sign in.”
• Select “Benefits and claims” in the top menu and select “ID card” from the dropdown menu.
• On the ID Card page, select “Print card.”

To see a summary of your specific prescription benefit information (e.g. progress toward your deductible, information about the out-of-pocket maximum), visit OptumRx and follow these steps:

• Go to www.optumrx.com, enter your username and password, and click “Sign in.”
• Select “Benefits and claims” in the top menu and select “Benefits information” from the dropdown menu.

UVA employees have the option to use the UVA Pharmacy. Prices at the UVA Pharmacy are often less expensive than at other pharmacies.

To search for other pharmacies, use the OptumRx pharmacy locator:

• Go to www.optumrx.com, enter your username and password, and click “Sign in.”
• Select “Pharmacy Locator.”
• Follow the prompts to find a pharmacy.

For medications classified as Specialty Drugs, use the UVA Specialty Pharmacy. See “Get Specialty Drugs” below for additional information.

OptumRX offers home delivery for 90-day supplies of some medications at reduced prices. Shipping is free. 

For more information, or to set up home delivery, use the following steps:

• Go to www.optumrx.com, enter your username and password, and click “Sign in.”
• Select “Home delivery.”
• To learn more about home delivery, click on “What is Home Delivery?” in the introductory paragraph.
• To order medications for home delivery, follow the prompts.

Use these additional resources:

• Preventive Prescription Coverage – provides information about preventive medications (e.g. contraceptives or aspirin).
• Medications Covered by OptumRx – the OptumRx Formulary lists covered medications, explains how prescription coverage works, and gives specifics requirements (e.g. Specialty Drugs).
• Exclusions – shows medications that are not covered by OptumRx and provides preferred alternatives.
• Specialty Drugs – identifies medications classified as Specialty Drugs by OptumRx. For more information, see “Get Specialty Drugs” below.

You may also research medications, and pricing, on the OptumRx website:

• Go to www.optumrx.com, enter your username and password, and click “Sign in.”
• Select “Drug search.”
• Begin typing the name of the medication you want and select it from the list that appears.
• On the page for that medication, you may view drug info, pricing, or lower-cost options- if available.

Some medications have been classified by OptumRx as Specialty Drugs for a variety of reasons, including: cost, availability, special storage requirements, etc. Specialty Drugs may be subject to quantity limits, require step therapy for users, or require prior authorization.

To get Specialty Drugs, you must use the UVA Specialty Pharmacy, which can be reached at 434.297.5500 or specialtymedsrx@virginia.edu.

Certain medications have been classified by OptumRx as part of the Step Therapy Program. This helps to reduce costs for expensive medications by first offering cost-effective alternatives. The OptumRx Formulary, a list of medications covered by OptumRx, shows if a drug requires Step Therapy.

OptumRx limits the quantities of some covered medications to remain within clinical dosing guidelines. Quantity-limited medications are more likely to be overused, or may be prescribed outside of clinical dosing guidelines. In some cases, there are also specific recommended dosages based on medical guidelines.

If you are prescribed a medication underneath the quantity limit, it will be covered and no additional steps need to be taken.

If you are prescribed a quantity-limited medication above the limit, you need to get a prior authorization (see below) for the full prescription.

See the Quantity Limit Program Frequently Asked Questions for additional information.

Some medications require approval before they are covered by OptumRx. These drugs are noted in the OptumRx Formulary. Prior authorization is required for medications that are more likely to be overused or prescribed outside of clinical dosing guidelines. In some cases, there are specific dosages based on medical guidelines. Prior authorization is required for all specialty drugs.

If your medication requires prior authorization, OptumRx will contact your doctor to get the necessary information.

If your request for a prior authorization is denied, you may still fill your prescription - but OptumRx will not cover its usual portion of the costs.

You may start a prior authorization request online:

• Go to www.optumrx.com, enter your username and password, and click “Sign in.”
• Select “Benefits and claims” in the top menu and select “Prior authorization” from the dropdown menu.
• Select “Start request now”and follow the prompts to request a prior authorization. You may also see the status of in-process requests.

You can see your claims history for varying date ranges on the OptumRx website:

• Go to www.optumrx.com, enter your username and password, and click “Sign in.”
• Click on “Benefits and claims” in the top menu and select “Claim history” from the dropdown menu.