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.