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Medications can play an important role in maintaining your health.  

UnitedHealthcare has teamed up with Optum Rx as your care provider to help you find out what medications are covered, check out ways to lower your costs, see how to fill your prescriptions, and more.

Find out what medications are covered

When it comes to coverage, keep in mind that some medications may have requirements before filling them. Also, if a medication doesn't fit your budget, it's a good idea to remember your doctor is here to help—talk to them about lower cost options.

Prescription Drug List

The easiest way to find out if a prescription is covered is to check the Prescription Drug List (PDL) — which takes the most commonly prescribed medications and organizes them into cost tiers. For more on the PDL, see the Prescription Costs section.

Is your medication covered in the PDL?

Traditional 3-Tier

Specialty medications

Medications used to treat complex or rare conditions may need to be obtained from a specialty pharmacy. You may also be able to use our specialty pharmacy for ongoing support. Learn more by visiting Optum Specialty Pharmacy

How to manage medication costs

The Prescription Drug List (PDL) takes medications and places them into tiers, arranging them from lowest to highest cost.

$
Tier 1

Lowest Cost

Mostly generic and some name-brand medications

$$
Tier 2

Mid-range Cost

A mix of brand-name and generic medications

$$$
Tier 3

Higher Cost

A mix of brand-name and generic medications

  • Here are a few PDL tips:

Prescription medication costs - pricing by tiers

The Prescription Drug List (PDL) takes medications and places them into tiers, arranging them from lowest to highest cost. The cost of medications is based on the health plan you choose. 

Choice Plan  

Out-of-pocket limit for pharmacy benefits

  • Individual: $3,850
  • Family:       $7,700

Network Retail

  • Tier 1:       $20 copayment
  • Tier 2:       $50 copayment
  • Tier 3:       $70 copayment

Network Home Delivery

  • Tier 1:        $ 40 copayment
  • Tier 2:       $100 copayment
  • Tier 3:       $140 copayment

Out-of-Network

This plan does not include out-of-network coverage.

HMO  

Out-of-pocket limit for pharmacy benefits

  • Individual: $3,850
  • Family:       $7,700

Network Retail 

  • Tier 1:       $20 copayment
  • Tier 2:       $50 copayment
  • Tier 3:       $70 copayment

Network Home Delivery

  • Tier 1:        $ 40 copayment
  • Tier 2:       $100 copayment
  • Tier 3:       $140 copayment

Out-of-Network

This plan does not include out-of-network coverage.

POS

Out-of-pocket limit for pharmacy benefits

  • Individual: $3,850
  • Family:       $7,700

Network Retail 

  • Tier 1:       $20 copayment
  • Tier 2:       $50 copayment
  • Tier 3:       $70 copayment

Network Home Delivery

  • Tier 1:        $ 40 copayment
  • Tier 2:       $100 copayment
  • Tier 3:       $140 copayment

Out-of-Network Retail 

  • Tier 1:       30% coinsurance after deductible
  • Tier 2:       30% coinsurance after deductible
  • Tier 3:       30% coinsurance after deductible

Out-of-Network Home Delivery

  • Tier 1:        not covered
  • Tier 2:        not covered
  • Tier 3:        not covered

Ordering your medications

You have choices in the way you order your prescriptions.

Order in

With home delivery, you can order up to a 3-month supply of medications you take regularly.

Signing up is easy, and there's free standard shipping to U.S. addresses.

Head out

Pick up your medications at any of our UnitedHealthcare network pharmacies and it may help you save on costs.

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