Pharmacy and prescription drug benefits

If you’ve ever needed prescription drugs, you know they can play an important role in keeping you healthy. Maybe you take regular medications — or maybe you’ve only needed medication for specific treatments. No matter what, it’s helpful to know how your benefits work. It can help you get your prescriptions filled more easily and help you control costs too. Let’s walk through some tips on how to use your pharmacy benefits for prescription drugs.

Check into your prescription drug benefit

You’ll find the detail about most prescription drug benefits by looking at your plan’s Prescription Drug List (PDL), also called a Formulary. It’s a list of medications and how they’re covered by your plan. If you have a prescription for a certain kind of medication, you can look it up in your PDL to see how it’s covered.

How to find and use your Prescription Drug List (PDL)

You can sign in to your health plan account and look under your pharmacy and prescription coverage information to see your plan’s PDL. You may also view a general PDL, but you’ll need to confirm your specific coverage details before filling a prescription.

When your doctor prescribes medication, look at your list and talk about the cost. You can ask about a lower cost alternative if the drug your doctor chooses is too expensive or isn’t covered. At times, a similar drug can work just as well — like if there’s a generic version of the drug.

Here's a hint:

PDLs may change. If you have medications you take regularly, watch your PDL and track changes to stay ahead of possible changes in cost.

How to fill your prescriptions

With some plans, you have the choice to fill your prescriptions at a participating network pharmacy or with home delivery by mail.

Find a network pharmacy

Choosing a network pharmacy may help you save on costs. You can view list of pharmacies for your plan by signing in to your health plan account. If you don’t use a participating network pharmacy, you may have to pay the full retail price for your prescriptions.

You can also view a general list of pharmacies using the OptumRx Pharmacy Network Search.

Set up home delivery by mail

If your prescription medication benefit includes home delivery, you can avoid monthly trips to the pharmacy and you may save money too. 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. You can enroll in just a few steps when you sign in to your health plan account or call the number on your member ID card.

What is OptumRx?

On your prescription benefits, you may see the name OptumRx®, which is UnitedHealthcare’s pharmacy service provider. OptumRx may be included in your health plan benefits because it offers members coverage through a large network of retail chain and independent pharmacies, as well as through its mail service pharmacy known as OptumRx Home Delivery and the Optum Specialty Pharmacy.

Pharmacy by mobile app

UnitedHealthcare members with health plans through an employer may use the UnitedHealthcare app to help manage their medications. You can use the app to:

  • Set up and refill home delivery orders
  • Track your prescription history
  • Find network pharmacies
  • Compare medication prices

Tips that may help save money

Here are a few ideas that may help you save on your medications.

  •  Check your Prescription Drug List (PDL) often to stay ahead of changes in coverage
  • Talk to your doctor about lower-cost alternatives if a medication is too expensive
  • Sign in to your health plan account to find network pharmacies

Common pharmacy terms to know

Prior authorization

A requirement that your doctor explains why you need a certain medication before your plan decides how and if it will be covered.

Supply/quantity limits

The largest amount of medication your plan will cover per copayment or period of time. Some medications have quantity limits for quality and safety reasons.

Step therapy

When your plan requires you to try one or more medications before approving coverage for a different one.

Specialty medications

Medications used to treat complex or rare conditions that you may need to get from a specialty pharmacy.