Prescription - OptumRx

With OptumRx, can I continue to go to the same pharmacy?
You will have access to OptumRx® home delivery and a large network of retail pharmacies, including large national chains and many local pharmacies. After your plan moves, you will be able to go online or call us to help find a network pharmacy. You can also fill your prescription at an HSHS pharmacy.
Will the medication I'm currently taking be covered with OptumRx?
To learn if your medication is covered, check your plan’s formulary (list of covered medications) online on or after your effective date. You can also find out if you need to do anything before filling your next prescription.
What could my medication cost or coverage change?
Your cost or coverage could change for several reasons including:
• Medications could move to a different tier
• Medications may no longer be covered
• You may be required to get a prior authorization
(pre-approval for benefit coverage)
• You may be required to try other medications
first (step therapy)
• Medications may only be covered in certain
quantities or in a specified time period
Can I use HSHS pharmacies to obtain a 90-day supply of medications I take regularly?
Yes, you can have your prescription filled at an HSHS pharmacy for a 90-day supply.
What information does the formulary include?
The formulary is a list of commonly prescribed medications covered by your plan. It also:
• Identifies medications for certain conditions and organizes them into cost levels called tiers
• Lets you know if any medications require prior authorization or step therapy, which may affect how they are covered
• Includes additional information about (medications that may have quantity/supply limits or be considered specialty

To learn if your medication is covered after your plan moves to OptumRx, check your formulary on the app or online. You can also find out if you need to do anything before filling your prescriptions.
Who is OptumRx?
OptumRx will be your plan’s pharmacy care services manager. Our commitment is to help you get the most out of your prescription medication benefit. We provide safe, easy and cost-effective ways for you to get the medication you need.
What are the advantages of using OptumRx home delivery?
• Medications will be delivered directly to your door, which means fewer trips to the pharmacy.
• You will receive up to a 90-day supply, which may save you money on copays
• Pharmacists will be available by phone 24 hours a day, 7 days a week to answer questions.
• You can set up automatic reminders to help you remember when to take your medication and refill your prescriptions.
• Enroll in our Hassle-Free FillSM program and we’ll automatically refill and deliver your eligible maintenance medications to you.
Will my current home delivery prescription(s) transfer to OptumRx?
Most home delivery prescriptions with remaining refills will automatically transfer. However, prescriptions for certain medications will not transfer. Examples include controlled substances and prescriptions that have expired. In these cases, you’ll need a new prescription from your doctor.
How will I order my prescriptions from OptumRx home delivery?
  • By e-prescribe. Your doctor can send an electronic prescription to OptumRx
  • Go online. Visit the website on your member ID card
  • By mobile app. Open the OptumRx app, which you can download from the Apple® App Store® or Google Play™
  • By phone. Call the toll-free number on your member ID card
Where can I fill my specialty prescription?
You can fill your prescription at Optum® Specialty Pharmacy. Our patient care coordinators and pharmacists are trained to understand your special therapy needs.
What are specialty medications?
Specialty medications treat chronic conditions such as cancer, multiple sclerosis and rheumatoid arthritis. It can be an injectable, oral or inhaled medication with one or more of the following characteristics:

• May require ongoing clinical oversight and additional education for best management
• Have unique storage or shipping requirements
• May not be available at retail pharmacies
Will my specialty medication automatically transfer to Optum?
No, your specialty medication will not automatically move. We will help you transfer your medication(s) after your coverage starts. In January 2020, you can:

• Call a specialty representative at 1-855-427-4682.
• Register online at specialty.optumrx.com.We will contact your doctor and take care ofeverything else.