Prescription drug coverage is administered by OptumRx and is packaged with your medical enrollment.
On this page:
- Member Services and Online Tools
- Plan Coverage
- Pharmacy Network
- Formulary Listing of Preferred Medications
- Home Delivery
- Specialty Medications
- Submitting a Claim
Member Services and Online Tools
You may access your account by:
- Calling the Syracuse University Member Services number on your prescription cards: 866-854-2945 (TTY: 711). OptumRx Member Services is available 24/7.
- Registering for secure online access at www.optumrx.com. Dependents 18 and older must register for their own online account, but may give you permission to view their claim information.
- Downloading the mobile app through iTunes or Google Play by searching for OptumRx
Using the website or the mobile app, 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
Prescription drug coverage is included with the medical plan option that you select. No separate enrollment is needed, and your medical rate includes the cost of prescription drug coverage.
|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: Generic||20% coinsurance*||15% coinsurance*|
|Tier 2: Preferred Brand Drug||25% coinsurance||25% coinsurance|
|Tier 3: Non-Preferred Brand Drug||45% coinsurance||40% coinsurance|
|Home Delivery: Your Cost
(up to a 90-day supply)
|Tier 1: Generic||$20 copayment*||Lesser of $15 or 15% coinsurance*|
|Tier 2: Preferred Brand Drug||$50 copayment||Lesser of $45 or 25% coinsurance|
|Tier 3: Non-Preferred Brand Drug||$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|
*Certain generic preventive care prescription drugs are covered at $0 copay. Age and gender restrictions may apply.
Prescription Drugs Available at $0 Copay:
- Breast Cancer Prevention Drugs
- Colonoscopy Preparation Prescriptions
- Folic Acid
- Iron Supplements
- Tobacco-Cessation Drugs (FDA approved, includes Over-the-Counter Products)
- Vitamin D Supplements
- Women’s Contraceptives
There are over 68,000 participating pharmacies in the OptumRx network, including most national chain pharmacies as well as independent local pharmacies. You can search for a participating pharmacy online by logging into www.optumrx.com, 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 by BriovaRx.
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 formulary is a list of the drugs OptumRx 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 1 = Generic Preferred
Tier 2 = Brand Name Preferred
Tier 3 = Non-Preferred
Note: non-preferred drugs are still eligible for partial coverage under the plan. A drug that is excluded is not eligible for any plan coverage. Talk with your prescriber about covered alternatives for excluded drugs to avoid paying full retail price.
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 OptumRx’s online formulary when you log into the secure member website at optumrx.com.
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, but are priced, on average, about 80% lower than the brand-name product. 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.
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 at optumrx.com. Orders are generally received within 14 days.
Use the OptumRx Home Delivery Order Form to mail in prescriptions and payment to OptumRx. Your health care provider can also e-prescribe or fax prescriptions on your behalf.
NOTE: You can fill up to a 90-day supply of medication either at a retail pharmacy or through OptumRx 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 Price and Save tool on optumrx.com, or call OptumRx Member Services at 866-854-2945 (TTY: 711), to determine which method is best for each drug you take.
Certain medications that treat complex medical conditions, require special monitoring or handling, or are self-injectible are considered specialty drugs and are dispensed through a specialty pharmacy, BriovaRx. Contact BriovaRx at 855.427.4682 (TTY: 800-735-2922) to set up your account and coordinate delivery of your medication.
Submitting a Claim
Present your OptumRx member ID card at a participating pharmacy. Home delivery and specialty claims are processed automatically for you. Use the OptumRx Reimbursement Form to submit a claim for an out-of-network pharmacy.
Every effort has been made to ensure that the information contained within this website is accurate. However, the 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.