Prescription Drug

Kaiser Members 

Your Prescription Drug benefits are provided by Kaiser. For more information, see Fund Kaiser.

Comprehensive Health Plan Members

On July 1, 2013, the Plan contracted with OptumRx to provide you with prescription drugs at negotiated contract rates when you use one of the pharmacies participating in the OptumRx network. Get the comprehensive prescription drug formulary information for active participants at OptumRx Active Participant formulary link.

Using a participating pharmacy works to your advantage in two ways:

  • Your payments for covered drugs are limited to the amounts shown on the Benefit Schedules.
  • You don’t have to worry about submitting a claim for reimbursement – you pay your copayments at the time of purchase, and the pharmacy bills the Fund for the remaining cost.

How to Use the Prescription Drug Program

  • If you need medication immediately for acute, short-term use, such as antibiotics, take your prescription and your OptumRx Identification Card to one of the participating retail pharmacies. The pharmacy will check your eligibility electronically, fill your prescription, and charge you the applicable copayment only. If you do not have your ID card with you, you will need to pay the full cost of the prescription(s) and submit a claim to OptumRx for reimbursement.
  • For medication you need immediately, but will continue taking on a long-term basis, ask your physician for two prescriptions. The first should be written for a 7-14 day supply to be filled at a participating retail pharmacy. The second should be written for the balance up to a 90-day supply, with refills, to be sent to the OptumRx Mail Service Pharmacies. Complete a mail service order form, and send it to OptumRx along with the original long-term prescription. Using Mail Order whenever possible will help reduce your prescription drug costs.
  • Refills at a retail pharmacy can be ordered by internet, phone or mail. The information included with your last order will show the date you can request a refill and the number of refills you have left.
  • For the OptumRx Mail Service Program, you can order refills online at OptumRx.com, by calling your Customer Care number below, or by mail. Make sure to attach the refill label provided with your last order to a mail service order form. Enclose payment with your order, if your plan requires a payment.
  • Additional ID cards can be obtained by calling OptumRx Customer Care at 1-888-798-4258.

OptumRx Contact Information  

Toll Free Customer Care     1-855-672-3644(TTY711)

Specialty Pharmacy    1-866-218-5445 Website  

Doctors Call for Prior Authorization 1-866-218-4555, Option 1

http://optumrx.com/

Mail Service Address

OptumRx

OptumRx Claims Department

P.O. Box 29044
Hot Springs, AR 71903

Comprehensive Prescription Drug Plan Summary

Prescription Drug Benefits
Prescription Drug Benefits
Participating Retail Pharmacy (Your copayment) Generic Drug - $5
Preferred Brand Name Drug* - $25 after annual deductible**
Non-Preferred Brand Name Drug* - $40 after annual deductible**
(Copay applies to each 34-day supply)
For PPI drugs, copayment does not apply. Plan payment is limited to $30 for a 34-day supply. You are responsible for the difference between the cost of the drug and the $30 plan payment.
* If a generic drug is available, and a brand name drug is dispensed for any reason other than the prescribing doctor has indicated "dispensed as written", you will pay the cost difference between the brand name and generic drugs plus the brand name copayment.
** $100 per person annual deductible applies to brand name drugs purchased at a retail pharmacy.
Non-Participating Retail Pharmacy You pay the copayments shown above for drugs from participating pharmacies plus any amount the pharmacy charges beyond the contract amounts the participating pharmacy would have charged.
Mail Order (Your copayment) Generic Drug - $10
Preferred Brand Name Drug - $50
Non-Preferred Brand Name Drug - $80
For PPI drugs, copayment does not apply. Plan payment is limited to $90 for a 90-day supply. You are responsible for the difference between the cost of the drug and the $90 plan payment.

Specialty Drugs (your copayment) Generic: 20% to $50 maximum copay, Brand: 20% to $100 maximum copay, Non-preferred: 20% to $200 maximum copay

Refer to the Summary Plan Description for a complete list of benefits, limitations and exclusions.