Frequently asked questions about pharmacy coverage

Prescriptions can be filled at any network pharmacy. If you are traveling and away from your home pharmacy, find your closest network pharmacy and call to fill your prescription.

If you're new to Optum Specialty Pharmacy and want to begin filling your prescriptions, start your fill . If you are a current patient, sign in and request a prescription refill. Once we receive your request, our pharmacy team will work with you and your doctor's office to fill your prescription and provide knowledgeable assistance and education.

We offer convenient delivery of medications directly to your home or preferred location. We use experienced carriers to help ensure your medications are carefully shipped. If your medications require special handling or refrigeration, they will be packed and shipped accordingly. There is no cost for shipping or handling.

If your medication requires prior authorization, it means you must get plan approval before the medication will be covered. To start the prior authorization process, call the number on your member ID card. Optum Rx^@ will contact your doctor to help make sure your prescribed medication is the right medication, is beneficial to your condition, and is the correct dosage for you.

In some cases, you may be prescribed a medication that is not covered by your plan.

This could happen because medications have been shown to offer no additional clinical and/or financial value over others in their class. In that case, they may not be covered under your plan. However, we understand this can be disruptive for members, so we only exclude a drug when it meets specific clinical and savings criteria.

You can find more information about specific prescription drug coverage by signing in to your plan.

Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, determined by your benefit plan. This is how much you will pay when you fill a prescription. The Prescription Drug List, also known as a Formulary, gives you choices so you and your doctor can determine the best course of treatment. Using lower tier medications can help you pay your lowest out-of-pocket cost. Your plan may have multiple or no tiers.

Members who need help obtaining early prescription refills can call an advocate at the number on their member ID card.

Medicare Parts A & B, or Original Medicare, cover drugs administered during hospital or doctor visits, but not medications you are prescribed to take after those visits have concluded. Many people who qualify for Medicare Parts A & B choose to supplement that coverage with a Medicare Part D prescription drug coverage plan.

Medicare Part D plans offer coverage for common generic and brand name prescription drugs, with the government setting guidelines for what medications Medicare Part D plans must cover. However, the prescription drugs covered do vary from plan to plan. Be sure to verify that your prescriptions are covered in each plan’s list of covered medications.

Current members may find more information about their specific prescription drug coverage by signing in to your health plan account.

Explore UnitedHealthcare and Medicare Part D plan options where you live

You must be enrolled in Medicare Part A and/or Part B to enroll in Part D. You are eligible for Medicare Part D (prescription drug plan) coverage if you are eligible for Medicare. If you are a U.S. citizen or qualified legal resident and meet one of the following, you may be eligible:

• Age 65 or older
• Younger than 65 with a qualifying disability
• Any age with a diagnosis of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s Disease)

To qualify as a legal resident, you must have lived in the United States for at least 5 years in a row before applying for Medicare.

Most Medicaid plans cover some prescription drugs. But exactly which ones can change from state to state. Also, different states may have different rules for copayments and cost sharing, so not all medicines may be fully covered.

If you qualify for both Medicaid and Medicare, also known as a dual health plan, it’s a type of Medicare Advantage plan and includes Medicare Part D. That means you could get more prescription coverage than you may have now with Medicaid or Original Medicare plans.

You can find more information about specific prescription drug coverage by signing in to your health plan account.

Learn more about the UnitedHealthcare Dual Complete® health plan