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) |
