Pharmacy and prescription drug benefits
Prescription drugs can play an important role in your health, whether you need them every day or once in a while. Knowing how your benefits work may help you fill your prescriptions more easily and help manage costs. Let’s walk through how to use your pharmacy and prescription drug benefits.
Tips for using your pharmacy benefit
Ask about lower cost options
If a prescribed medication is in a higher cost tier, ask your doctor if a lower cost option will work for you. A similar drug or generic version can often work just as well.
See if you need prior authorization
Some medications need prior authorization. This means your doctor must explain why you need the drug. Then your plan decides how or if they will cover it. To start the prior authorization process, call the number on your member ID card.
Review your PDL regularly
Keep in mind that PDLs may change. If you have prescriptions you take regularly, watch for notifications about PDL updates and possible cost changes.
Look for ways to save
If you’re a UnitedHealthcare member, there are pharmacy programs that may be available to help you save on costs.
Are you an Oxford or Affordable Care Act (ACA) Marketplace plan member? View pharmacy benefit information for UnitedHealthcare Individual & Family ACA Marketplace plans and Oxford plans.
Want to shop over-the-counter (OTC) products?
Visit the Optum Store and shop for nonprescription medications, everyday essentials and more.
How to fill your prescriptions
With some plans, you can fill your prescriptions at a participating network pharmacy or with home delivery.
Find a network pharmacy
Choosing a network pharmacy may help you save on medication costs. Sign in to your member account to view a list of pharmacies included in your plan’s network.
Set up home delivery
Plans that include home delivery help you avoid regular trips to the pharmacy and may save you money. You can enroll through your online account or by calling the number on your member ID card.
What is Optum Rx?
You may see the name Optum Rx on your prescription benefits. This is the UnitedHealthcare pharmacy service provider. Optum Rx offers coverage through a large network of retail chain pharmacies and independent pharmacies. It also offers coverage through its mail order pharmacy, Optum Home Delivery®.
Frequently asked questions
You can search the Optum Rx pharmacy network to view general network pharmacy locations. Before filling a prescription, make sure to confirm your plan’s specific coverage details. Sign in to your member account to view your prescription benefit details. Members can also view plan details with the UnitedHealthcare app.
Many plans may offer cost savings if you fill your prescriptions at a pharmacy within the plan's preferred network. Sign in to your member account to view your plan’s preferred network pharmacies.
If your prescription drug benefit includes home delivery, you can choose to have medications delivered by mail through Optum Home Delivery. You may be able to order up to a 3-month supply of medication you regularly take — and there’s usually no charge for standard shipping within the U.S. Sign in to your member account to enroll or call the number on your member ID card.
Members can compare medication prices in the UnitedHealthcare app. You can download the app now if you don’t already have it.
Medications used to treat complex or rare conditions, such as cancer, hepatitis C and multiple sclerosis, are called specialty medications. You may need to get these medications filled at a specialty pharmacy, which provides educational and clinical support for these types of medications. Visit the Optum Specialty Pharmacy or call the number on your member ID card to find a specialty pharmacy for your medication.