Optum Rx Benefit

HPHC subscribers are eligible to participate in the prescription drug delivery and clinical management program administrated by OptumRx. The company participates with all national pharmacy chains and many local pharmacies. The service allows you to:

  • Manage all your prescriptions on a single dashboard.
  • Update your information and complete health profile home delivery.
  • Order mail order refills.
  • Compare prices at local pharmacies and find your lowest prescription cost.
  • Keep track of your health history
  • Learn more about your medications.

Go to OptumRx.com to register or download the OptumRx app from either Google Play or the App Store. You will need your HPHC subscriber ID #. Your OptumRx information can be found on your Health Plan card (look for the OptumRx logo).

Covered Services

Tufts EPO Value Deductible

Tufts EPO Premium

PPO

In-Network

PPO

Out-of-Network*

Prescription Drugs

(up to a 30-day supply)

$15 Tier I

$30 Tier II

$50 Tier III

$15, Tier I

$30, Tier II

$50, Tier III

$15, Tier I

$30, Tier II

$50, Tier III

Reimbursable at In-Network level

Mail Order Rx Drugs

(up to a 90-day supply)

$30 Tier I

$60 Tier II

$150 Tier III

$30, Tier I

$60, Tier II

$150, Tier III

$30, Tier I

$60, Tier II

$150, Tier III

Reimbursable at In- Network level

Specialty Drugs

(up to a 30-day supply)

$15, Tier I

$30, Tier II

$50, Tier III

$15, Tier I

$30, Tier II

$50, Tier III

 

 $15, Tier I

$30, Tier II

$50, Tier III

not covered

* Deductible applies first

3-tier program

Covered medications are categorized into one of three tiers. Copayments are determined by the tier in which the drug is assigned, for up to a 30-day supply per prescription or refill.
  • Tier 1 is primarily made up of generic drugs and select brand-name drugs that the plan has determined to be more effective, less costly or to have fewer side effects than similar medications. Members pay the lowest copayment or coinsurance amount for Tier 1.
  • Tier 2 is primarily made up of brand-name drugs, and higher cost generic drugs.
  • Tier 3 is made up of drugs that the plan has not included in Tier 1 or Tier 2. Members pay the highest copayment or coinsurance amount for Tier 3 drugs.