Officers - Prescription Drug Coverage
When you enroll in any University medical plan, you are automatically enrolled in the Prescription Drug plan, administered by OptumRx.
Accessing Your Benefit
To find participating pharmacies or enroll in the OptumRx mail-order program, log in to myuhc.com and choose “Manage Your Prescriptions” or call 800-232-9357 for assistance.
Using Your Benefit
The cost of your prescriptions depends on a number of factors, including whether you buy your medication through a retail pharmacy or through the mail-order program and whether the drug is Tier I, Tier II or Tier III.
Copays
Copays for prescription drugs work differently under the Choice Plus plans and the High Deductible Health Plan (HDHP).
Under the Choice Plus plans, all prescription drugs are subject to a copay.*
Under the High Deductible Health Plan (HDHP), preventive drugs and nonpreventive drugs are treated as follows:
- Preventive Drugs: Prescription drugs categorized as “preventive” under federal guidelines are not subject to the HDHP deductible, so you are only responsible for paying the copay. Copays accumulate toward your out-of-pocket maximum. Preventive drugs under federal guidelines include medications such as anticoagulants, cholesterol lowering agents and prenatal vitamins. Check if your prescription is on the Covered Preventive Medications List.
- Non-Preventive Prescription Drugs: Prescription drugs categorized as “non-preventive” under federal guidelines are subject to the HDHP deductible. This means you will pay the entire cost for your non-preventive prescription drugs until you meet the plan deductible. Once the deductible is met, the prescription drug copay will apply. Note: you will receive a discount on the cost of your prescription drugs if you use an OptumRx participating pharmacy.
Prescription Drug Copays
Tier Descriptions:
- Tier 1: Lower-cost generics and some brand names
- Tier 2: Mid-range cost preferred brand names
- Tier 3: Higher-cost brand names and some generics
Eligible specialty medications will be processed through PillarRx with a 30% coinsurance, offset by the manufacturer discount. You will be notified in advance if you need to enroll.
To check if your prescription is considered preventive, see the Covered Preventive Medications List.
Copays and deductibles accumulate toward the out-of-pocket maximum of all plans. After you reach the annual out-of-pocket maximum, the plans pay 100% of the cost of preventive and non-preventive prescription drugs.
*$30,000 lifetime maximum for infertility medication.
You need to present your UHC ID card the first time you fill a prescription. You can have up to a 30-day supply of your prescription when filled at a retail pharmacy.
- In New York, New Jersey and other states, a pharmacy is required by law to substitute a brand name drug with a generic. Your copay is $10 or the cost of the generic drug, whichever is less.
- If no generic is available for your prescription, your drug is Tier 2 and you will pay $25.
Note: Non-preventive drugs in the HDHP are subject to the medical plan deductible. After the deductible is met, copays will apply.
Using the prescription drug mail-order program, you can order up to a 90-day supply. Recommended for people who use medication on a regular basis, mail-order should be less expensive than retail pharmacies and offers easy refill—online or by phone.
To enroll log in to OptumRX mail-order program or find participating pharmacies, log in to myuhc.com and choose "Manage Your Prescriptions" then "Order Prescriptions" or call 800-232-9357 for assistance.
Specialty medications must be purchased via mail-order from Optum Specialty Pharmacy. Optum Specialty Pharmacy will mail your prescription in an unlabeled package to you at the address of your choice.
Call 855-427-4682 to speak to a patient care representative to get started. Typically, you will receive a 30-day supply of the prescription at the retail pharmacy copay.
Note: If you use any pharmacy other than Optum Specialty Pharmacy, you will be subject to the full cost of the medication, not a copay.
Columbia University partners with the IPC Copay Assistance Program administered by PillarRx to reduce your costs for certain eligible high-cost medications that you may be taking to manage your health. This is a confidential program managed directly by PillarRx.
ID Card
UHC ID cards have member information for medical, vision, and prescription drug coverage. You do not need separate cards for each benefit. After enrolling in a medical plan, it can take three weeks for a UHC ID card to arrive in your mail. If necessary, you can print a temporary UHC ID card two weeks after enrolling. Create an account on myuhc.com to print a temporary ID card. Use your Social Security Number, date of birth, and Group number 712790.