Save Money on Prescription Needs

Prescription Drug Program

Breaking News

New 14-digit Optum ID cards will be mailed on Friday, January 11, 2019. These will be effective January 1, 2019. Please allow 3-5 business days for delivery. New Member ID cards will have a print date of January 9 or January 10, 2019. Replace any card that was printed prior to those dates. Review the Optum announcement for more information. The letter from Optum will look like this.

Prescription Drug Program

Participants in the UVA Health Plan automatically have prescription drug coverage managed by OptumRx. Costs for prescriptions vary for Choice, Value, or Basic Health.

More about UVA Health Plans 

UVA Health Plan changes can be made during Annual Enrollment each October, or after a major life change (change in marital status, addition to the family, or a leave of absence).

What are the costs?

Prescription needs and costs are factors to consider when choosing a UVA Health Plan option. Pricing for prescriptions vary based on your health plan option.

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).

Some medications are identified as specialty drugs. These drugs must be purchased from the UVA Specialty Pharmacy and have specific guidelines (e.g. limits on the supply amount).

For specific information about covered medications and pricing tiers, review the OptumRx Formulary. To determine if a medication is classified as a specialty drug, review the Specialty Drug List.

UVA Pharmacy

Remember that 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.

Premiums

Your UVA Health Plan premiums cover prescription drugs as well. More on the UVA Health Plan.

Deductible

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 prescription deductible of $100 per person for tier 2 and tier 3 retail drugs. You must pay for covered prescriptions up to your prescription deductible amount before the UVA Health Plan begins to pay for tier 2 and tier 3 retail prescriptions. Tier 1 and mail order prescriptions are not subject to the prescription deductible.

In-Network Deductibles

In-Network Deductibles include:

  • Basic Health

    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.

  • Value Health

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

  • Choice Health

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

Out-of-Network Deductibles

Out-of-Network Deductibles include:

  • Basic Health

    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.

  • Value Health

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

  • Choice Health

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

How do I use my prescription drug coverage?

UVA Health Plan prescription coverage varies between the Basic Health option and the Value or Choice plan options. For specific information about prescription coverage and costs use the following resources:

  • Register at www.OptumRx.com

    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.

  • Get a prescription drug card

    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.”

  • Review your specific prescription benefits

    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.

  • Find a pharmacy

    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.

  • Set up home delivery

    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.

  • Get medication information and pricing

    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.

  • Get Specialty Drugs

    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.

  • Understand Step Therapy

    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.

  • Learn about Quantity Limits

    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.

  • Get a Prior Authorization

    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.

  • Review claims

    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.

How do I prepare for out-of-pocket expenses?

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.

Who do I contact for help?

For questions about UVA Health Plan’s prescription coverage, (prior authorizations, quantity limits, and step therapy), contact OptumRx:

877.629.3123

www.optumrx.com

Resources

Prior Authorization FAQ

Quantity Limit List

Quantity Limit FAQ

Step Therapy Program FAQ