OptumRx administers the prescription drug coverage for the University’s health plans as of January 1, 2016. Prior to that, Express Scripts (formerly known as Medco) administered prescription drug benefits. If you need to submit a claim for a prescription that you filled on or before December 31, 2015, submit it to Express Scripts.
- Information About the Transition to OptumRx
- OptumRx and Catamaran Have Merged
- Plan Design and Contributions
- Pharmacy Network
- Formulary Listing of Preferred Medication
- Home Delivery and E-Prescribing
- Specialty Medications
- Submitting a Claim
- Rx Frequently Asked Questions
Information About the Transition to OptumRx
The three-month transition period for any member affected by a change in the prescription drug formulary ended April 1, 2016. Prescriptions filled after this date will be covered in accordance with the Syracuse University benefit plan design and applicable OptumRx coverage policies or utilization management programs.
OptumRx and Catamaran Have Merged
OptumRx has acquired another prescription benefit manager called Catamaran, and the Catamaran name will be used for some time as the two companies integrate. You may access your account by:
- Calling the Syracuse University Member Services number on your prescription cards: 866-854-2945 (TTY: 711). OptumRx Member Services is available 24/7.
- Registering for secure online access at www.optumrx.com/myCatamaranRx. (Note: www.optumrx.com is not the correct website.) Dependents 18 and older must register for their own online account, but may give you permission to view their claim information.
- Downloading the mobile app through iTunes or Google Play by searching for OptumRx/CatamaranRx
Using the website or the mobile app, you can:
• Check your cost for prescriptions
• View your ID card
• Locate participating pharmacies
• Set medication reminders and see your medication history
• Re-order your home delivery medications
Plan Design and Contributions
Prescription drug coverage is included with the medical plan option that you select. Your contributions to the medical plan include the prescription drug benefits associated with your medical plan.
There are over 68,000 participating pharmacies in the OptumRx network, including most national chain pharmacies as well as independent local pharmacies. You can search for a participating pharmacy online by logging into www.optumrx.com/myCatamaranRx, or using the mobile app. You can also choose to use the convenient home delivery option for medications that you take on a daily basis. Specialty drugs will be filled by BriovaRx.
Formulary Listing of Preferred Medications
Your cost share under the plan is determined by two factors: whether you use a retail pharmacy or home delivery, and the formulary tier your drug is on. A formulary is a list of the drugs OptumRx has selected as the preferred medication(s) in each drug class based on their safety, efficacy, and cost. A drug can be placed on one of three tiers:
Tier 1 = Generic Preferred
Tier 2 = Brand Name Preferred
Tier 3 = Non-Preferred
Note: non-preferred drugs are still eligible for partial coverage under the plan. A drug that is excluded is not eligible for any plan coverage. If you choose to fill a prescription for an excluded drug, you will pay the full retail price.
A formulary can be updated at any time, especially as new drugs are introduced to the market and generic equivalents become available for brand-name drugs. This can affect your share of the cost. You can search OptumRx’s online formulary when you log into the secure member website at optumrx.com/myCatamaranRx.
Generic medications are FDA-approved drugs that contain the identical active ingredient in the same strength as the brand-name drug. Generic drugs must meet the same standards for safety, purity, potency and quality as the branded drug, but are priced, on average, about 80% lower than the brand-name product. To encourage the use of generics, if a generic is available and you or your doctor choose to get the brand name drug (by checking the “Dispense as Written” box on the prescription), you will pay the generic copay plus the difference between the brand-name drug cost and the generic drug cost.
Home Delivery and E-Prescribing
Catamaran is the name of the home delivery pharmacy. If you take certain medications on a daily basis, you may wish to fill those prescriptions using home delivery, which offers convenient mail order service with free standard shipping. Enroll in home delivery at optumx.com/myCatamaranRx. Orders are generally received within 14 days. When you use home delivery, the mail-order cost sharing applies, which may result in significant savings. Savings vary for each medication and savings are not guaranteed.
Use the OptumRx Home Delivery Order Form to mail in prescriptions and payment to OptumRx. Your health care provider can also e-prescribe or fax prescriptions on your behalf.
Certain medications that treat complex medical conditions, require special monitoring or handling, or are self-injectible are considered specialty drugs and are dispensed through a specialty pharmacy, BriovaRx. Contact BriovaRx at 855.427.4682 (TTY: 800-735-2922) to set up your account and coordinate delivery of your medication.
Submitting a Claim
Present your OptumRx member ID card at a participating pharmacy (be sure to destroy your Express Scripts or Medco member ID cards). Home delivery and specialty claims are processed automatically for you. Use the OptumRx Reimbursement Form to submit a claim for an out-of-network pharmacy.
If you need assistance with prescription drug claims that were filled on or before December 31, 2015, you must contact Express Scripts Member Services at 800.230.0508 and use the Express Scripts Reimbursement Form. Express Scripts was formerly known as Medco.