Prescription Drugs

OptumRx is the administrator of prescription drug benefits for the University of Miami's medical plan.

Four Tier Structure

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  • Four Tier Structure

    Costs are determined by Optum's four-tier structure. If the cost of the prescription is less than the copayment, you pay the lesser amount. In the HRA plan, copays apply after you have met your deductible.

    Medications may move up or down a tier throughout the plan year. These changes can occur because of the availability of new medications or if the FDA makes a new recommendation about an existing medication. 

    Note, any prescription NOT covered by OptumRx is the full responsibility of the member and WILL NOT be applied toward your deductible or out-of-pocket maximum.

    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)

  • Formulary

    Click here to view the 2022 list of covered drugs and costs.

Maintenance Medications

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  • Maintenance Medications

    Important: Save on your copay by filling your 90-day prescription for maintenance medications at your local Walgreens pharmacy or through OptumRx Home Delivery. Other retail pharmacies may not be used for 90-day supplies of maintenance medications. 

    If you fill your maintenance medications monthly (in 30-day increments), your copayment will increase by 2½ times after the second filled 30-day prescription. 

    Tier 2 Rx Example

    Local retail pharmacy
    (monthly cost, 30-day supply)

    OptumRx Home Delivery or 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 OptumRx Home Delivery. If the cost of your medication is lower than the copay, you pay the lower cost.

    Learn more about the OptumRx Walgreens90 Saver program here.

On Campus Pharmacies

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  • On Campus Pharmacies

    Walgreens at Lennar Foundation Medical Center

    Walgreens at Sylvester Comprehensive Cancer Center

    Walgreens at UHealth Tower

    Pharmacy at Bascom Palmer Eye Institute

    Pharmacy at Sylvester Comprehensive Cancer Center


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  • 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 OptumRx at 1-800-711-4555, option 2. 

Specialty Pharmacy

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Additional Resources

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