Prescription Drug Coverage

Syracuse University provides you with access to prescription drug coverage as part of your health plan enrollment.  The University partners with OptumRx to provide you with this valuable benefit.

On this page:

Member Services and Online Tools

You may access your account by:

  • Calling the OptumRx 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 OptumRx mobile app.

Using the website or the mobile app [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

Plan Coverage

Below is a summary of the differences between the options available under SUBlue, SUOrange and SUPro:

Prescription Drug PlanSUBlue and SUOrangeSUPro
Annual DeductibleNo deductibleNo deductible
Out-of-Pocket Maximum$2,000 single/$4,000 family$2,000 single/$4,000 family
Retail Pharmacy: Your Cost
Tier 120% coinsurance*15% coinsurance*
Tier 225% coinsurance25% coinsurance
Tier 345% coinsurance40% coinsurance
Home Delivery: Your Cost
(up to a 90-day supply)
Tier 1$20 copayment*Lesser of $15 or 15% coinsurance*
Tier 2$50 copaymentLesser of $45 or 25% coinsurance
Tier 3$90 copaymentLesser of $90 or 40% coinsurance
Specialty Home Delivery: Your Cost
Specialty MedicationsSame as Home Delivery, except up to a 30-day supply
Infertility MedicationsFollows above schedule for retail, mail order and specialty with a $20,000 lifetime maximum

*Prescription Drugs Available at $0 Copay (Certain Age, Gender and Other Restrictions May Apply; Contact OptumRx for More Details at 866.854.2945, TTY: 711): 

  • Aspirin
  • Breast Cancer Prevention Drugs
  • Cholesterol-Lowering Medications
  • Colonoscopy Preparation Prescriptions
  • Fluoride
  • Folic Acid
  • Iron Supplements
  • Pre-exposure Prophylaxis (PrEP) Therapies
  • Tobacco-Cessation Drugs (FDA approved, includes Over-the-Counter Products)
  • Vitamin D Supplements
  • Women’s Contraceptives

Pharmacy Network

Most national chain pharmacies as well as independent local pharmacies participate with the OptumRx network. You can search for a participating pharmacy online by logging into OptumRx 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 not eligible for any plan coverage. Talk with your prescriber about covered alternatives for excluded drugs to avoid paying full retail price.

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 = Includes lower-cost generics and some brand-name drugs
Tier 2 = Includes mid-range cost preferred brand-name drugs
Tier 3 = Includes highest-cost non-preferred drugs

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.

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 OptumRx website.  Orders are generally received within 14 days.

Print and complete the OptumRx Home Delivery Order Form [PDF] to mail in prescriptions and payment to OptumRx. Your health care provider can also e-prescribe or fax prescriptions on your behalf.

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 the OptumRx website, or call OptumRx 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, require special monitoring or handling, or are self-injectable are considered specialty drugs and are dispensed through the Optum Specialty Pharmacy. Contact OptumRx at 844.265.1761 (TTY: 711) 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. Print and complete the OptumRx Prescription Reimbursement Form [PDF] to submit a claim from an out-of-network pharmacy.

Should you have any questions, please reach out to our HR Shared Services team at 315.443.4042.

Helpful Links

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.