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Prescription Drug Program

Mail Order Program - Optum RX

A mail-order program is available with HealthSelect and all HMO coverage. Through this program, up to a 90-day supply of a prescription can be obtained (3-month payment for 90-day supply).

Cost to Employee

A $50 deductible applies to each member per plan year (January 1 - December 31). After deductible is met, member will be charged the appropriate co-payment.

Table 1: Prescription Drug Cost to Employee

 

Tier 1

Tier 2

Tier 3

Participating retail non-maintenance $10
up to a 30-day supply
$35
up to a 30-day supply if generic is not available*
$60
up to a 30-day supply if generic is not available*
Participating retail maintenance $10
up to a 30-day supply
$45
up to a 30-day supply if generic is not available*
$75
up to a 30-day supply if generic is not available*
All carrier mail order programs $20
For 31-60 day supply

$30
For 61-90 day supply
$70
For 31-60 day supply if generic is not available*

$105
For 61-90 day supply if generic is not available*
$120
For 31-60 day supply if generic is not available*

$180
For 61-90 day supply if generic is not available*
HealthSelect Extended Days Supply (EDS) Pharmacy Network $20
For 31-60 day supply
$30
For 61-90 day supply
$70
For 31-60 day supply if generic is not available*

$105
For 61-90 day supply if generic is not available*
$120
For 31-60 day supply if generic is not available*

$180
For 61-90 day supply if generic is not available*

*If generic is available and you choose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.

Page updated: 09/08/2021