You are automatically enrolled in the prescription drug plan administered by OptumRX when you enroll in one of the medical options.
The prescription drug plan provides retail and mail services. Under the retail network service, you can visit any in-network pharmacy for your short-term prescription drug needs. For a 30-day drug supply, the following co-payments apply:
- $5 for generic drugs
- $30 for preferred brands (See Drug Formulary)
- Drug Exclusions
- $45 for non-preferred brands
- $100 for specialty drugs (See Drug Formulary)
Note: Specialty drugs may be subject to utilization management and may require extra approvals before being covered.
The mail service program must be used for maintenance or long-term medications. This will save you time and money, as you will receive a 90-day supply delivered to your home for the following co-pays:
- $12 for generic drugs
- $60 for preferred brands
- $90 for non-preferred brands
- $200 for specialty drugs (when clinically appropriate)
Mail Service Requirement: You may receive your first three refills for long-term or maintenance medications under the retail network service. Your fourth and future refills must be obtained through the mail service to avoid higher co-payments. Long-term or maintenance medications filled at retail after the first three refills will be subject to double the retail co-payments for up to a 30-day supply ($10 for generic, $60 for brand, or $90 for brand non-formulary). However, 90-day supplies may be filled at the Notre Dame Wellness Center at the mail-order co-payment amounts.
OptumRX offers participants several online services such as:
- Benefit plan information
- Coverage comparisons on home delivery, retail brand-name, and generic medications
- Online prescription orders, tracking prescription status, and viewing up to 18 months of prescription history.
Generic Drug versus Brand-Name Drugs
Generic Drugs: Generic drugs are chemically identical to brand name drugs, but are sold under their chemical generic name. Generic drugs must contain the same active chemical ingredients and be equivalent in strength and dosage form to the brand-name product. The federal Food and Drug Administration regulates the quality, strength, and purity of generic drugs.
Brand-Name Drugs: Brand-name drugs that are advertised and sold under a product name chosen by the manufacturer. In general, brand-name drugs are more expensive than generic drugs.
Specialty Drugs & Medications (click here for a list of specialty drugs)
Specialty medications are drugs that are used to treat complex conditions, such as cancer, growth hormone deficiency, hemphilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis. Whether they are administered by a healthcare professional, self-injected, or taken by mouth, specialty medications require an enhanced level of service.
Over the past several years, specialty drugs have been introduced in the marketplace. Currently there are several hundred specialty drugs in the drug pipeline pending FDA approval for release in the next few years. Specialty drug spending is one of the fastest growing components of our pharmaceutical drug costs. Because of this, we have been partnering with Briovarx.com, specialty pharmacy for OptumRX, to provide services for our members, which will provide benefit consistency and consistency in the application of clinical protocols.
BriovaRX is dedicated to serving the needs of patients living with complex conditions that require specialty medications. BriovaRX provides:
- Enhanced clinical training, privacy and support
- 24/7 access to specialized nurses and pharmacists
- Access to products and services
- Compliance monitoring and side-effect mentoring
- Refill reminders
- Benefit consistency
- Shipping convenience
If you or a family member are prescribed a specialty medication, BriovaRX may be reaching out to
you and your physician.