Pharmacy programs

When your new UnitedHealth care member or existing member needs help and additional time to speak with their physician about switching to a preferred or covered alternative medication and/or satisfying their drug’s clinical program requirements, the manual Transition of Care process (TOC) can help.

• Manual TOC allows UnitedHealthcare Customer Service to approve a one-time, one-month override on certain medications that are strategically excluded or have clinical review requirements (e.g. Prior Authorization, Step Therapy) when the member is new to UHC pharmacy benefits or the member is impacted by a Prescription Drug List (PDL) Cycle change.
• Manual TOC applies to both new and existing members.
• Members simply call the number on the back of their ID card to request a TOC override.
• UnitedHealthcare Customer Service will work with your member to determine if their drug is eligible for a Transition of Care override.
• For existing members to be eligible, they must also have a paid claim within the last 120 days in their history. The override is not available for new medications. Existing members should have a denied claim in their history for the drug under review in order to help streamline the process.

You can get help to manage your prescription medications and save money, too. If you’re covered under an eligible benefit plan, you can receive:

• $20 off your copayment or coinsurance when you refill your prescription for a qualifying medication as prescribed (usually once per month).
• $50 off your copayment or coinsurance for mail-order refills of qualifying medications for a 90-day supply.

Call the number on your health plan ID card to see if your medications and health plan qualify for this program. Qualifying medications include:

• Advair®
• Breo®
• Ellipta®
• Symbicort®

The Copay Card Solutions Accumulator Benefit program is designed to apply a member’s true out of pocket costs to their deductible and out-of-pocket maximum when manufacturer coupons are used at Optum Specialty Pharmacy. Call the number on your health plan ID card to find out if this is part of your plan.

The use of copay cards from drug companies has become more popular with high-cost specialty medications. They can lower your out-of-pocket costs but may increase the plan’s cost on some high-cost and non-preferred medications. Our new program lets you take advantage of the full value of manufacturer’s copay cards without changing your current out-of-pocket costs.

We take a hands-on approach to patient care. This means that we work with you and your medical team to make decisions based on what’s best for your complex needs.

With infusion pharmacies and nurses across the country, we can administer high-quality, cost-effective infusion therapies for short- and long-term conditions in the comfort of your home or a nearby outpatient infusion suite.

For infusion pharmacy needs, please contact Optum Infusion Pharmacy at 1-855-427-4682 or visit the Optum infusion pharmacy page.

Specialty prescription medications are used to treat complex conditions such as cancer, Hepatitis C, and multiple sclerosis.

• It’s important to get specialty prescriptions filled at a specialty pharmacy because they provide educational and clinical support specifically for these types of medications.
• Call the phone number on your health plan ID card or visit Optum Specialty Pharmacy to find a specialty pharmacy for your medication.

Split Fill Program Drug List 2022 - Certain specialty medications may be dispensed by a designated pharmacy in 15-day supplies up to 90 days to make sure you will tolerate the medication.  Your copayment or coinsurance will be prorated.

My ScriptRewards will help members manage high-cost medications, if they are covered under a participating health plan. It will be available to members who take preferred drugs in select categories:

• Immunomodulators
• Multiple sclerosis
• Growth hormone

If you switch to a preferred drug in one of the these categories, you could receive $250 in rewards every 6 months -- as long as you continue filling your prescriptions and the program is available.

To find out if you qualify, call the number on the back of your health plan ID card.

Smart RxAssist may help reduce patient costs with manufacturer copay assistance programs. Call the phone number on the back of your ID card to see if this is a part of your benefits.