Prescription Coverage

Our prescription benefits are provided by OptumRx and administered by RxBenefits, Inc. There are more than 64,000 pharmacies in your pharmacy network.

You may access a copy of the most recent preferred drug list and formulary exclusions at www.optumrx.com or by contacting RxBenefits at 1-800-334-8134.

Tiered Cost of Rx

Retail Pharmacy (30 Day Supply)
Generic (Tier 1) $10 copay
Preferred (Tier 2) 30% to $100
Non-Preferred (Tier 3) 50% to $250
Retail Pharmacy (90 Day Supply)
Generic (Tier 1) $30 copay
Preferred (Tier 2) 30% to $300
Non-Preferred (Tier 3) 50% to $750

Mail Order

Retail Pharmacy (30 Day Supply)
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1) $20 copay
Preferred (Tier 2) 30% to $200
Non-Preferred (Tier 3) 50% to $500

Specialty Medications

Retail Pharmacy (30 Day Supply)
Specialty Medications (30 Day Supply)
Specialty medications must be ordered through Briova Rx at 1-800-850-9122 and are limited to a 30 day supply 50% to $250
Medical and Rx:
Summary of Benefits and Coverage (SBC)

Video: Prescription Drug Benefits

Video: Managing RX Costs