For all things pharmacy, turn to Optum Rx
UnitedHealthcare plans use Optum Rx® for pharmacy care services. We’ve designed it to be easier for you to save on medications and easier to keep track of them, too — whether you’re online or on the go.
Making meds more affordable
UnitedHealthcare’s Vital Medication Program offers eligible members the following select prescription drugs with a $0 cost-share:
- Insulin - rapid, short-and long-acting for diabetes
- Epinephrine - allergic reactions
- Glucagon - hypoglycemia (low blood sugar)
- Naloxone - opioid overuse
- Albuterol inhaler – asthma
Please call us at 888-297-0878 for more information on Prescription Drug cost and coverage.
See if your medications are covered
Using the Prescription Drug List (PDL) is the easiest way to find out which prescription drugs are covered by a plan. It includes both brand-name and generic prescription drugs approved by the U.S. Food and Drug Administration.
Drug lists can and do change, so its always good to confirm coverage. Please call us at 888-297-0878 for more information on Prescription Drug Cost and Coverage.
See if your medication is covered:
Find preventive medications covered at no cost:
How to use the Prescription Drug List
The Prescription Drug List (PDL) arranges medications into tiers, and each tier is assigned a cost that’s determined by your employer or health plan. Choosing medications from the lower tiers may help you save money.
Tier 1: Lowest cost
Medications that provide the highest overall value - includes mainly generics and some brand-name options
Tier 2: Mid-range cost
Medications that provide good overall value - includes a mix of brand-name and generic drugs
Tier 3: Highest cost
Medications that provide the lowest overall value and the highest cost - Mostly brand-name drugs as well as some generics. Many Tier 4 drugs have lower-cost options in Tiers 1, 2 or 3.
Important
Certain medications may be excluded from coverage or subject to prior authorization. Prior authorization is an approval process required by some medications before your plan can approve your prescription.
A prior authorization (PA) or exception request (ER) is needed when a formulary restriction requires a review by the health plan to determine if specific prescribing criteria are met before approval of coverage is granted. A PA or ER also might be needed if there is a step therapy requirement, a quantity limit, or if the medication is not included on the formulary (list of drugs).
To start the prior authorization process, you or the prescriber need to contact us. Typically, when necessary, your doctor or nurse will submit a PA or ER to the health plan on your behalf.
Please note that submitting a request does not guarantee approval.
Manage your specialty medications
Specialty medications
Specialty medications are typically high-cost medications used for complex or rare conditions. These medications can be injectable, oral or inhaled and may need ongoing clinical oversight, have unique shipping or storage requirements or are not typically available at retail pharmacies.
Specialty pharmacy program
The Optum Specialty Pharmacy is available to covered members using a specialty medication. Once you’re a member, you can register to access personalized support.
2 ways to fill your prescriptions
Network pharmacy
Pick up your medications at any of the many pharmacies in our UnitedHealthcare network.
Home delivery
With home delivery, you can order up to a 3-month supply of medications you take regularly.
Answers to questions to help you understand your pharmacy benefits
Please note: The above questions and answers are a general description of coverage benefits. You should refer to your official plan documents.
Medications are categorized by common therapeutic conditions in this reference guide for ease of reference only. These categories do not determine coverage for the medication for your condition. Your benefit plan determines how these medications may be covered for you.
Plan documents: Where differences are noted between this reference guide and your benefit plan documents, the benefit plan documents will govern.
Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates.
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