Syracuse University provides you with access to prescription drug coverage as part of your health plan enrollment. The University partners with Optum Rx to provide you with this valuable benefit.
Plan Coverage
Below is a summary of the differences between the options available under SUBlue, SUOrange and SUPro:
| Prescription Drug Plan | SUBlue and SUOrange | SUPro |
|---|---|---|
| Annual Deductible | No deductible | No deductible |
| Out-of-Pocket Maximum | $2,000 single/$4,000 family | $2,000 single/$4,000 family |
| Retail Pharmacy: Your Cost | ||
| Tier 1 | 20% coinsurance* | 15% coinsurance* |
| Tier 2 | 25% coinsurance | 25% coinsurance |
| Tier 3 | 45% coinsurance | 40% coinsurance |
| Home Delivery: Your Cost (up to a 90-day supply) |
||
| Tier 1 | $20 copayment* | Lesser of $15 or 15% coinsurance* |
| Tier 2 | $50 copayment | Lesser of $45 or 25% coinsurance |
| Tier 3 | $90 copayment | Lesser of $90 or 40% coinsurance |
| Specialty Home Delivery: Your Cost | ||
| Specialty Medications | Same as Home Delivery, except up to a 30-day supply | |
| Infertility Medications | Follows above schedule for retail, mail order and specialty with a $20,000 lifetime maximum | |
*Certain Preventive Prescription Drugs Available at $0 Copay (Age, Gender and Other Restrictions May Apply; Contact Optum Rx for More Details at 866.854.2945, TTY: 711)
Member Services
You may access your account by:
- Calling the Optum Rx member services number on your prescription card: 866.854.2945 (TTY: 711). They are available to assist you 24/7.
- Registering for secure online access. Dependents 18 and older must register for their own online account, but may give you permission to view their claim information.
- Downloading the Optum Rx mobile app.
Using the Optum Rx Digital Action Guide [PDF], you can:
- Check your cost for prescriptions
- View your ID card
- Locate participating pharmacies
- Set medication reminders and see your medication history
- Re-order your home delivery medications
Pharmacy Network
Most national chain pharmacies as well as independent local pharmacies participate with the Optum Rx network. You can search for a participating pharmacy online by logging into Optum Rx or using the mobile app. You can also choose to use the convenient home delivery option for medications that you take on a daily basis. Specialty drugs must be filled through the Optum Specialty Pharmacy.
Formulary Listing of Preferred Medications
Your cost for a drug covered by the plan is determined by two factors: whether you use a retail pharmacy or home delivery, and the formulary tier your drug is on. A drug that is excluded is generally not eligible for any plan coverage. Talk with your prescriber about covered alternatives for excluded drugs to avoid paying full retail price, or your provider may contact Optum Rx directly to initiate a request for a prior authorization review to be completed.
A formulary is a list of the drugs Optum Rx has selected as the preferred medication(s) in each drug class based on their safety, efficacy and cost. A drug can be placed on one of three tiers on the formulary, tier one, tier two and tier three.
A formulary can be updated at any time, especially as new drugs are introduced to the market and generic equivalents become available for brand-name drugs. This can affect your share of the cost. You can search Optum Rx’s online formulary when you log into the secure member website.
Generic medications are FDA-approved drugs that contain the identical active ingredient in the same strength as the brand-name drug. Generic drugs must meet the same standards for safety, purity, potency and quality as the branded drug. To encourage the use of generics, if a generic is available and you or your doctor choose to get the brand name drug (by checking the “Dispense as Written” box on the prescription), you will pay the generic copay plus the difference between the brand name drug cost and the generic drug cost.
Home Delivery
If you take certain medications on a daily basis, you may wish to fill those prescriptions using home delivery, which offers convenient mail order service with free standard shipping. Enroll in home delivery through the Optum Rx website. Orders are generally received within 14 days.
You can fill up to a 90-day supply of medication either at a retail pharmacy or through Optum Rx home delivery. When you use home delivery, the mail-order cost-sharing applies, which may result in significant savings over your cost at a retail pharmacy. Savings vary for each medication and savings are not guaranteed. Use the pricing tool on the Optum Rx website, or call Optum Rx Member Services at 866.854.2945 (TTY: 711) to determine which method is best for each drug you take.
Specialty Medications
Certain medications that treat complex medical conditions or require special monitoring or handling, may be considered specialty drugs and are dispensed through the Optum Specialty Pharmacy. Contact Optum Rx at 844.265.1761 (TTY: 711) to set up your account and coordinate the delivery of your medication.
Submitting a Claim
Present your Optum Rx member ID card at a participating pharmacy. Home delivery and specialty claims are processed automatically for you. Contact Optum Rx for instructions on how to submit a claim from an out-of-network pharmacy.
Should you have any questions, or require accommodations to access any information on this webpage, please reach out to HR Shared Services at 315.443.4042.
Helpful Links
- Benefits Eligibility Policy
- Optum Rx Member Website
- Optum Rx Digital Action Guide [PDF]
- Optum Rx Home Delivery Prescription Order Form [PDF]
Every effort has been made to ensure that the information contained within this website is accurate. However, benefits are governed by legal documents (which, in certain circumstances, may include insurance contracts). If there is any difference between the information in this website and the official documents, the official documents will control. As is the case with all of Syracuse University’s employee benefit plans, the University reserves the right to modify or terminate these benefits at any time.