For the 2021 plan year, the university’s Prescription Plan will transition from the Select to the Premium Formulary and implementing Utilization Management programs. Here are a few key changes:
- Transitioning to Home Delivery for Maintenance Medications, with the option to opt-in with an additional copay at retail pharmacies.
- Through December 31, members will have access to OptumRx Pharmacy Portals to (1) verify prescription coverage and/or any requirements (i.e. prior authorization or step therapy) and (2) verify prescription cost. Instructions for how to use the OptumRx Pharmacy Portals are provided to the right.
- Behavioral health prescriptions that are impacted by the pharmacy changes will have a 12-month advance notice period. Impacted members will be notified by OptumRx, and are encouraged to begin working with their health care provider in early 2021.
- OptumRx has mailed notification letters to impacted members at their home residence and has made outbound calls to those members who have multiple prescriptions impacted. Members may call OptumRx at (844) 265-1875 with questions. Maintenance mail order letters will be mailed out after the first refill in 2021.
- Those enrolled in the university’s medical plan will receive new insurance cards for BlueCross BlueShield and OptumRx with an updated member ID and group number – cards will be mailed directly to your home in mid-December. Members are also encouraged to download the OptumRX mobile app to manage prescriptions.
To verify if a prescription drug will be covered and/or if it has restrictions beginning January 1, 2021, follow these steps:
1. Prescription Drug Lookup portal
2. Enter drug name
3. Click search icon
4. Click Coverage Details
5. Review Status Row
6. Review Restrictions – Prior Authorization, Step Therapy, Quantity Limit
To verify the cost* of a prescription drug, follow these steps:
1. Prescription Drug Pricing portal
2. Enter zip code or address and select radius
3. Click Apply
4. Enter drug name
5. Click search icon
6. Review Coverage Alert, if applicable
7. Review prices
*Drug prices are subject to change based on individual retail pharmacies.