Prescription Drug Coverage
As a member of the Boston University Health Plan, you will automatically be enrolled in prescription drug coverage through OptumRx. When your doctor prescribes medication, you have choices about where and how the prescription is filled.
Register with OptumRx to Manage Your Prescriptions
Once you are enrolled in a health plan, you can register with OptumRx. As a registered member, you can use the site to manage your prescription drug benefits. Order refills, sign up for text message reminders, track your orders, view the status of your claims, use their mobile website, and more.
OptumRx covers medically necessary prescription medication. Some drugs require prior authorization in order to be covered by the plan. To learn about a specific medication, visit the OptumRx website.
Your prescription costs vary depending on whether your prescribed medication is a generic, preferred brand-name, or non-preferred brand-name drug (preferred brand-name medications are selected based on their clinical effectiveness and opportunities for savings). An independent Pharmacy and Therapeutics Committee updates this list regularly based on continuous evaluation of medications.
The out-of-pocket maximum of $2,000 for single coverage and $4,000 for family coverage for prescription drug expenses is separate from the medical out-of-pocket maximum with the PPO Plan.
Members can determine whether their brand-name medications are preferred or non-preferred by logging in to OptumRx.
Your out-of-pocket cost for prescription drugs are listed below:
|Expense||Your Cost for Prescription Drugs|
|Retail Pharmacy (per 30 day supply)||
You pay 100% (not covered)
|Preferred Brand||20% coinsurance ($40 minimum, $60 maximum)|
|Non-preferred Brand||30% coinsurance ($60 minimum, $80 maximum)|
|Mail Order (per 90 day supply)|
|Preferred Brand||20% coinsurance ($80 minimum, $120 maximum)|
|Non-preferred Brand||30% coinsurance ($120 minimum, $160 maximum)|
When you need short-term medication (e.g., for the flu or an ear infection), with the Retail Network Pharmacy Service you can take your prescription to almost any major pharmacy chain (CVS, Walgreens, Walmart, Costco, Rite Aid, Osco, etc.) and many independent pharmacies. Simply show your ID card and pay your co-payment.
New for 2019: Receive 90-day Supply at CVS Pharmacy!
Receive a 90-day Supply at CVS Pharmacy. In response to employee requests to fill prescriptions for a 90-day supply of medications at a retail pharmacy, we are pleased that effective January 1, 2019 OptumRx has partnered with CVS Pharmacy to give BU Health Plan members the option to get 90-days of maintenance medication at retail CVS pharmacies for the cost of a 60-day supply.
- The OptumRx CVS90 Saver program allows you to get 90-day supplies of your maintenance medications at nearly 9,700 CVS Pharmacy locations or through OptumRx home delivery — the choice is yours.
- Your pharmacy benefit covers only a limited number of 30-day refills of a maintenance medication. After the allowed refills, you must choose to fill your prescription from OptumRx home delivery or CVS Pharmacy, or pay double the 30-day supply cost.
- If you decide not to use either home-delivery or the OptumRx CVS90 Saver program, you will pay double the 30-day supply cost.
- If you choose to fill a maintenance medication prescription at a non-CVS retail pharmacy, you will pay double the 30-day supply cost.
Home Delivery Pharmacy Service
If you take medication for a chronic condition, such as diabetes or asthma, you can get a prescription from your doctor for up to a 90-day supply, plus refills, for the rest of the year, and then order your medication through the Home Delivery Pharmacy Service. Print a mail order delivery order form. Orders may be placed by mail, online, over the phone, or by having your physician fax the prescription to OptumRx. There are no shipping costs unless you request express shipping. Note that regular mail takes 7–11 days from the date you place your order; it’s faster if you order by phone, Internet, or fax. A refill slip, including the date you can order the next refill, will come with every order. It’s safe, easy, and the least expensive way to purchase your medication.
Health Savings Plan
Prescription drug expenses count toward the same deductible and out-of-pocket maximum as any other medical expense.
For non-preventive medications you pay the full amount of the prescription drug until you reach the medical plan deductible. Then, you pay 10% coinsurance up to the annual out-of-pocket maximum. The coinsurance percentage you pay is the same, regardless of where and how your prescription is filled.
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