Pharmacy - Optum Rx - CDH
Your pharmacy benefits are provided under the County's self-insured pharmacy plan through OptumRx. Some of the plan features include:
- an open formulary with five tiers of coverage at affordable co-pays,
- a large network of participating pharmacies,
- a 90-day mandatory maintenance medication program (excludes specialty).
Consumer-Driven Health (CDH) Rx Plans - Copay Rates
|Specialty Pharmacy||$75||30 Day Supply Only|
|Dispense-as-Written (DAW1) & Excluded Drug ("Tried & Failed")||$75||$150|
*Pharmacy can only fill a 30-day supply for maintenance medication 3 times before requiring a 90-day refill.
Plan Clinical Prior Authorization Program
Certain prescriptions require “clinical prior authorization,” or approval from your plan, before they will be covered. The categories/medications that require clinical prior authorization may include, but are not limited to: Acne (topical-after age 24), ADHD/Narcolepsy (after age 19), Botulinum Toxins, Lamisil/Sporanox, Obesity and Peniac. Upon receipt of a prescription falling into a covered category, Catamaran will contact your doctor’s office and request the documentation needed for Prior Authorization.
Pharmacy Plan (UHC and CCP) - Specialty Drugs Only: HDHP Plans: Manufacturer copay/financial assistance is a great benefit to help pay for costly Specialty drugs. In the past, manufacturer assistance was applied outside of the plan and the actual cost paid by the member was not accurately applied to their annual health deductible and coinsurance accumulators. This was an unintended benefit due to pharmacy systems not being able to apply the manufacturer assistance first. Effective January 1st, 2020, members using Specialty drugs through OptumRx (Briova) (UHC) or Southern Scripts (CCP) will have the manufacturer assistance applied up front and only the actual amount a member pays out of pocket will be applied to their annual deductible or coinsurance accumulators. Member will continue to receive the same financial assistance from the manufacturer; however, that assistance will now be incorporated into the member’s health deductible and coinsurance.
Member Services: 1-855-356-3216
On-Site Reps: 954-357-7191 & 7192
OptumRx specialty pharmacy provider. They will assist members with their specialty medications to ensure safe and effective administration. BriovaRx provides free home delivery to your home/work address. Please contact BriovaRx for more information regarding specialty pharmacy.
Member Services: 855-427-4682