Prescription Drug Coverage

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.

On this page:

Member Services and Online Tools

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 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

*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)

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 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 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, require special monitoring or handling, or are self-injectable are 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

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.