OptumRx is the administrator of prescription drug benefits for the University of Miami's medical plan.
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)
Click here to view the 2022 list of covered drugs and costs.
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. Local retail pharmacy 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.
Tier 2 Rx Example
(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
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
305-351-0606
305-423-1757
305-702-9065
305-326-6520
305-243-5244
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.
Optum supports specialty treatments and take a hands-on approach to patient care that makes a meaningful imprint on the health and quality of life of each patient. Members can count on their guidance, education, and compassion throughout the entire course of treatment. To get started, click here or call 1-855-427-4682.
Click here to view the 2022 list of specialty pharmacy drugs.
Prescription Reimbursement Request Form
Specialty Pharmacy: 1-866-218-5445
www.OptumRx.com
305-284-3004
www.miami.edu/benefits/ask