Save Money on Prescription Needs
COVID-19 OPTUM COMMUNICATIONS
Participants in the UVA Health Plan automatically have prescription drug coverage managed by OptumRx. Costs for prescriptions vary for Choice, Value, or Basic Health. Therefore, prescription needs and costs are factors to consider when choosing a UVA Health Plan option, as pricing for prescriptions vary based on your health plan option.
In order for a prescription drug to be covered under UVA’s health plan, it must be listed on the Formulary. View the Premium Formulary to see the prescription drugs covered by the UVA Health Plan. For the most UpToDate formulary log onto the OptumRx site or download the OptumRx app.
Both generic and brand name prescriptions are offered. There are different pricing tiers that impact your coinsurance amount, (e.g. the percentage you pay of the approved cost after your deductible is met).
Tier categories are listed in the Formulary as Tier 1, 2, 3 or E. Any drug shown as Tier E is excluded from coverage by the UVA Health plan.
Specialty drugs must be purchased from the UVA Specialty Pharmacy and have specific guidelines (e.g. limits on the supply amount).To determine if a medication is classified as a specialty drug, review the Specialty Drug List. (specialty drug must be on Premium Formulary for coverage).
Medication prices at the UVA Pharmacy are often less expensive than those at other pharmacies for UVA employees. You can use the number below to contact the UVA Pharmacy for all of your specialty pharmacy needs.
Your UVA Health Plan premiums cover prescription drugs as well.
Contraceptive drugs and over-the-counter preventative items mandated by the Affordable Care Act are covered at no cost to employees.
Medications on the Preventive Medication List do not have a deductible, coinsurance may still apply.
Basic Health participants have a deductible that applies to both medical and prescription costs. You must pay for covered health care services and prescriptions up to your deductible amount before the UVA Health Plan begins to pay.
Value and Choice Health participants have a deductible that applies to both medical and prescription costs for tier 2 and tier 3 retail drugs. You must pay for covered prescriptions up to your deductible amount before the UVA Health Plan begins to pay for tier 2 and tier 3 retail prescriptions. Tier 1, and specialty prescriptions are not subject to the deductible.
See deductible information on the UVA Health Plan webpage.
The table below shows costs for retail Pharmacy outside of UVA Pharmacies (such as a CVS, Kroger, etc.) Excludes Specialty Rx and Mail Order Prescriptions
| Tier | Choice | Value | Basic |
|---|---|---|---|
| 1 (Generic, low cost) | $6 co-pay 30-day supply |
$6 co-pay 30-day supply |
Deductible + 20% for up to 90-day supply |
| 2 (Brand, Preferred) | Deductible + 20% $34 min / $150 max 30-day supply |
Deductible + 20% $34 min / $150 max 30-day supply |
Deductible + 20% for up to 90-day supply |
| 3 (Brand, Non-Preferred) | Deductible + 20% $68 min / $225 max 30-day supply |
Deductible + 20% $68 min / $225 max 30-day supply |
Deductible + 20% for up to 90-day supply |
The table below shows costs for retail Pharmacy at UVA pharmacies only, such as UVA, Emily Couric Clinical Cancer Center, UVA Bookstore, Zion Crossroads, and UVA Cancer Center Augusta Pharmacies. Excludes Specialty Rx and Mail Order Prescriptions
| Tier | Choice | Value | Basic |
|---|---|---|---|
| 1 (Generic, low cost) | $6 co-pay 30-day supply |
$6 co-pay 30-day supply |
Deductible + 20% for up to 90-day supply |
| 2 (Brand, Preferred) | Deductible + 20% $Up to $150 max 30-day supply |
Deductible + 20% $30 min / $150 max 30-day supply |
Deductible + 20% for up to 90-day supply |
| 3 (Brand, Non-Preferred) | Deductible + 20% $60 min / $225 max 30-day supply |
Deductible + 20% $60 min / $225 max 30-day supply |
Deductible + 20% for up to 90-day supply |
The table below shows costs for Mail Order through Optum Rx Home Delivery. Excludes Specialty Rx and Retail.
| Tier | Choice | Value | Basic |
|---|---|---|---|
| 1 (Generic, low cost) | $14 co-pay up to 90-day supply |
$14 co-payup to 90-day supply | Deductible + 20% for up to 90-day supply |
| 2 (Brand, Preferred) | Deductible +15% $75 min / $375 max up to 90-day supply |
Deductible +15% $75 min / $375 max up to 90-day supply |
Deductible + 20% for up to 90-day supply |
| 3 (Brand, Non-Preferred) | Deductible +15% $150 min / $475 max up to 90-day supply |
Deductible +15% $150 min / $475 max up to 90-day supply |
Deductible + 20% for up to 90-day supply |
The table below shows costs for Specialty Pharmacy at UVA, available up to 30-day supply; may only be filled through UVA Specialty Pharmacy*
| Tier | Choice | Value | Basic |
|---|---|---|---|
| 1 (Generic, low cost) | 20% $100 max |
20% $100 max |
Deductible + 20% |
| 2 (Brand, Preferred) | 20% $150 max |
20% $150 max |
Deductible + 20% |
| 3 (Brand, Non-Preferred) | 20% $200 max |
20% $200 max |
Deductible + 20% |
In limited circumstances, specialty medications can be filled through OptumRX Specialty. UVA Pharmacy must be contacted first.
UVA Health Plan prescription coverage varies between Basic Health, Value, and Choice plan options. For specific information about prescription coverage and costs, use the following resources:
The first time you use the OptumRX website, you will need register.
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:
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:
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:
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:
The following resources will be helpful:
You may also research medications, and pricing, on the OptumRx website:
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 Premium 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 Premium 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:
You can see your claims history for varying date ranges on the OptumRx website:
To help UVA employees get the most out of your money for prescriptions, medical, dental, vision, and dependent-care expenses, the University offers benefits-related savings and spending accounts. These accounts allow you to put aside money for eligible expenses, by payroll deduction, before taxes.
Visit the UVA Basic Health with Health Savings Account page (HSA) to learn more about the HSA that can be used for prescription and other allowable expenses.
For information about UVA's medical and dependent daycare flexible spending accounts (FSAs), visit the Flexible Spending Account page.
For questions about UVA Health Plan’s prescription coverage, (prior authorizations, quantity limits, and step therapy), contact OptumRx: