If your plan includes pharmacy benefits, you have prescription drug coverage from network pharmacies and mail order.* Your copayment is based on levels called a prescription tier. The costs are lower on tier 1 and higher on tier 3, or tier 4 if applicable.
OptumRx, our online pharmacy benefit manager, has some great tools. When you register on OptumRx, you can view your medication history and copays, find a network pharmacy, see how much your medications will cost, and if there are any restrictions. View our prescription drug lists in PDF format or sign in to OptumRx to use the drug lookup tool. If you’re an HPN Balance Plan member, your pharmacy network does not include Walmart, Sam's Club, CVS or CVS inside Target.
Mail order pharmacy
Use our contracted mail order pharmacy* to save time and money. Download and print an order form. Then fill it out and mail it (along with your prescription and the applicable copayment) to OptumRx, PO Box 2975, Mission, KS, 66201.
Your provider should write your prescription for a 90-day supply with refills when appropriate (not a 30-day supply with three refills).
Need assistance? Fill out Section 1 of the OptumRx fax order form. Then ask your provider to fill out Section 2 and fax the form for you.
To refill a prescription, please call 1-800-788-4863 or refill online.
*This doesn’t affect any high-cost specialty drugs you may receive through the mail from BriovaRx.
You may be required to try step therapy. This means you must try certain drugs to treat your medical condition before we’ll cover another drug for that condition. You may submit an exception request to waive step therapy requirements or quantity limit restrictions.