Prescription Drugs

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

Four Tier Structure

Open All Tabs
  • 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 2021 list of covered drugs and costs. *

     

    * OptumRx is temporarily holding formulary changes of select albuterol brand products that are scheduled for January 1, 2021. The manufacturer, Teva, has informed OptumRx that there is limited supply of generic Proair due to manufacturing challenges. The upcoming plan to exclude Proair will put additional strain on generic Proair supply and supply is not anticipated to meet demand.  

    Currently, supply of other generic albuterol products are stable such as generic Proventil and generic Ventolin. Due to pharmacy laws, generic Proair prescriptions cannot be automatically substituted with a generic Proventil or generic Ventolin

    To alleviate pressure on generic Proair supply and ensure members do not have access issues or interruption in therapy OptumRx will be making the following temporary formulary changes:

    • Maintain brand ProAir and Ventolin on tier 2 with quantity limit
    • Generic albuterol products continue to be covered


    2021 marketing materials will not be updated as these are temporary changes. OptumRx will continue to monitor the albuterol supply and communicate any further formulary changes, as needed. When supply stabilizes and a decision is made to implement the exclusions, impacted members will receive prior notification of the change.

Maintenance Medications

Open All Tabs
  • 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

Open All Tabs
  • On Campus Pharmacies

    Walgreens at Lennar Foundation Medical Center
    305-351-0606

    Walgreens at Sylvester Comprehensive Cancer Center
    305-423-1757

    Walgreens at UHealth Tower
    305-702-9065

    Pharmacy at Bascom Palmer Eye Institute
    305-326-6520

    Pharmacy at Sylvester Comprehensive Cancer Center
    305-243-5244

Pre-certification

Open All Tabs
  • 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. 

Additional Resources

Open All Tabs

Questions?

Open All Tabs