Officers - Prescription Drug Coverage

Prescription Drug Benefits

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 prescriptions depends on a number of factors, including the medical plan in which you are enrolled, whether you buy your medication through a retail pharmacy or through the mail-order program, and whether the drug is generic, single-source or multi-source.

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. To check if your prescription is considered preventive, go to 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

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.

  • If no generic is available, it is a single-source drug.
     
  • If both a generic and brand name prescription are available, it is a multi-source drug.

To find out if a drug is single-source or multi-source, ask your pharmacist or contact OptumRx at 800-232-9357 or www.myuhc.com. Keep in mind that your prescription may move from single-source to multi-source during the year due to periodic reviews by OptumRx or if the U.S. Food and Drug Administration (FDA) approves a generic equivalent drug.

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 "single-source" 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.

Effective January 1, 2022, Columbia University partnered 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.

Learn more about the IPC Copay Assistance Program

Information Notice

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.