Prescription Drug Coverage Provided through OptumRX
OptumRx is the administer of prescription drug benefits for the University of Miami's health plan.
Costs are determined by the four-tier structure below. If the cost of the prescription is less than the copay, you pay the lesser amount. In the HRA plan, copays apply after you have met your deductible. Drugs may move up or down a tier each year. Click here to view an updated list of covered drugs and costs.
| Tier |
Cost |
Description |
| Tier 1 |
$10 |
Covered preferred generic medications (not self-injectable). |
| Tier 2 |
$45 |
Covered preferred brand name medications (not self-injectable). |
| Tier 3 |
$75 |
Covered non-preferred generic and brand-name medications (not self-injectable). |
| Tier 4 |
$100 |
Preferred and non-preferred self-injectable drugs covered by prescription benefits. Insulin is covered under Tiers 1, 2, and 3 (tier depends on type). |
Important: Save on your copay by filling your 90-day prescription for maintenance medications at your local Walgreens pharmacy or through OptumRx Home Delivery. CVS retail pharmacies may no longer be used for ninety-day supplies of maintenance medications. If you fill your maintenance medications monthly (in 30-day increments), your copay will increase by 2½ times after the second filled 30-day prescription. See below.
| Tier 2 Rx Example |
Local Retail Pharmacy (monthly cost, 30-day supply) |
OptumRx Home Delivery or Local Walgreens Pharmacy (average monthly cost, 90-day supply) |
| First 30-Day Fill |
$45.00 |
$37.50 |
| 30-Day Refill #1 |
$45.00 |
$37.50 |
| 30-Day Refill #2 |
$112.50 |
$37.50 |
NOTE: Cost increase reflects permanent change in copay for this and all additional refills of the same medication for 30-day supplies at local retail pharmacy. 90-day supplies can only be obtained at Walgreens or through Optum Rx Home Delivery. If the cost of your medication is lower than the copay, you pay the lower cost.
Optum Rx / Walgreens 90-Day
UM Pharmacies
Daystar (305-284-5927)
Inpatient Pharmacy: (305-243-4281)
Outpatient Pharmacy: (305-243-5244)
Bascom Palmer Eye Institute: (305-326-6520)
Pre-certification
Based on FDA guidelines and current medical findings, precertification supports member safety and appropriate drug use, and helps keep health care costs manageable by requiring certain conditions for coverage. Drugs that require precertification can be found here. If you require a precertification, please have your physician contact Optum Rx at 1-800-711-4555, option 2.
Contact OptumRx
www.OptumRx.com
Customer Service: 1-855-438-4509
Specialty Pharmacy: 1-866-218-5445
