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. 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. Click here to view the 2020 list of covered drugs and costs.
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). |
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 OptumRx Home Delivery. If the cost of your medication is lower than the copay, you pay the lower cost.
OptumRx / 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 OptumRx at 1-800-711-4555, option 2.
Contact OptumRx
www.OptumRx.com
Customer Service: 1-855-438-4509
Specialty Pharmacy: 1-866-218-5445
