Pharmacy programs
Programs to help you save
There are a variety of programs designed to help you manage your prescriptions and save on costs.
When your new UnitedHealth care member or existing member needs help and additional time to speak with their physician about switching to a preferred or covered alternative medication and/or satisfying their drug’s clinical program requirements, the manual Transition of Care process (TOC) can help.
- Manual TOC allows UnitedHealthcare Customer Service to approve a one-time, one-month override on certain medications that are strategically excluded or have clinical review requirements (e.g. Prior Authorization, Step Therapy) when the member is new to UHC pharmacy benefits or the member is impacted by a Prescription Drug List (PDL) Cycle change.
- Manual TOC applies to both new and existing members.
- Members simply call the number on the back of their ID card to request a TOC override.
- UnitedHealthcare Customer Service will work with your member to determine if their drug is eligible for a Transition of Care override.
- For existing members to be eligible, they must also have a paid claim within the last 120 days in their history. The override is not available for new medications. Existing members should have a denied claim in their history for the drug under review in order to help streamline the process.
You can get help to manage your prescription medications and save money, too. If you’re covered under an eligible benefit plan, you can receive:
- $20 off your copayment or coinsurance when you refill your prescription for a qualifying medication as prescribed (usually once per month).
- $50 off your copayment or coinsurance for mail-order refills of qualifying medications for a 90-day supply.
Call the number on your health plan ID card to see if your medications and health plan qualify for this program. Qualifying medications include:
- Advair®
- Breo®
- Ellipta®
- Symbicort®
The Copay Card Solutions Accumulator Benefit program is designed to apply a member’s true out of pocket costs to their deductible and out-of-pocket maximum when manufacturer coupons are used at Optum Specialty Pharmacy. Call the number on your health plan ID card to find out if this is part of your plan.
The use of copay cards from drug companies has become more popular with high-cost specialty medications. They can lower your out-of-pocket costs but may increase the plan’s cost on some high-cost and non-preferred medications. Our new program lets you take advantage of the full value of manufacturer’s copay cards without changing your current out-of-pocket costs.
We take a hands-on approach to patient care. This means that we work with you and your medical team to make decisions based on what’s best for your complex needs.
With infusion pharmacies and nurses across the country, we can administer high-quality, cost-effective infusion therapies for short- and long-term conditions in the comfort of your home or a nearby outpatient infusion suite.
For infusion pharmacy needs, please contact Optum Infusion Pharmacy at 1-855-427-4682 or visit the Optum infusion pharmacy page.
Specialty prescription medications are used to treat complex conditions such as cancer, Hepatitis C, and multiple sclerosis.
- It’s important to get specialty prescriptions filled at a specialty pharmacy because they provide educational and clinical support specifically for these types of medications.
- Call the phone number on your health plan ID card or visit Optum Specialty Pharmacy to find a specialty pharmacy for your medication.
Specialty Medications Not Eligible for Coupons (Effective 5/1/2021)
Split Fill Program Drug List 2021 - Certain specialty medications may be dispensed by a designated pharmacy in 15-day supplies up to 90 days to make sure you will tolerate the medication. Your copayment or coinsurance will be prorated.
My ScriptRewards helps members manage high-cost prescription medication needs if covered under an eligible health plan. It’s currently available to members who take certain HIV medications:
- It allows you to fill certain HIV drug treatment combinations at a $0 cost-share
- If you fill one of these regimens you can receive a $250 prepaid debit card every 6 months, as long as you continue filling your prescriptions and the program is available.
To find out if you qualify, call 1-877-636-9712 or learn more here.
