Endowed Prescription Drug Coverage

optum rx logo

If you participate in any of the endowed health care plans, you are covered by the OptumRx prescription drug program. The OptumRx retail pharmacy network includes more than 68,000 participating pharmacies nationwide, including national pharmacy chains and independent community pharmacies.  You have the option of purchasing a prescription both inside and outside the broad network of pharmacies; however, you'll pay more at non-participating pharmacies. Call Member Services at (866) 533-6977 or log on to the OptumRx website to find out if your pharmacy is in the network.

 

ID Card

You will receive an OptumRx ID card in the mail following your enrollment. If you require a replacement, you can download a temporary ID or order a new one at OptumRx: https://www.optumrx.com/public/landing

Log into your account or register as a first-time user. Once at the home page click:
> Benefits and Claims
> ID Card
> Print card or enter quantity desired (1-9) and OptumRx will mail physical ID cards directly to you.

 

Purchasing Medication

You need to use your OptumRx card for all of your prescription drug purchases. Aetna will not be authorized to service your claims at the pharmacy counter or by mail order. Remember, you will still need to use your Aetna card to receive all other medical services.

If you purchase a prescription from a participating provider but do not have your OptumRx ID card to present to the pharmacist, you can still pay the applicable copay. Be sure to let the Pharmacist know that OptumRx is the insurer. Tell the Pharmacist:

  • Employee ID or SSN#
  • BIN:  610011
  • PCN:  IRX
  • RxGroup:  PURCORNEL

If you do not provide this information, you will pay more because OptumRx will reimburse you the contracted rate less the applicable copay. In addition, you'll need to submit a claim form to OptumRx to receive reimbursement. 

Forms & More Information

To submit an OptumRx Reimbursement Claim Form (note: reimbursement rate is contracted rate less applicable copayment):

  • Submit via Paper Form:

    • Download OptumRx Claim Form (pdf)
    • Complete, sign/date, include documents and make copies for your records
    • Mail to: OptumRx Claims Department, P.O. Box 29044, Hot Springs, AR 71903

 

2023 Prescription Drug Plan Co-Pays

(note: no changes from 2021)

Tier One: Covered generic drugs

Tier Two: Covered brand-name drugs on OptumRx Formulary

Tier Three: Covered brand-name drugs not on OptumRx Formulary**

Plan Features

In-Network Coverage (Preferred Benefit Level)*

Out-of-Network Coverage (Non-Preferred Benefit Level)

Retail Pharmacy (including insulin)

Tier 1: $5; Tier 2: $30; Tier 3: $50
Up to 30 day supply

 

Contracted rate less the applicable copay
Up to 30 day supply

Home Delivery Choices

Cornell Health Pharmacy
on Cornell Campus for safe and secure delivery

Or

Delivery to your home

Tier 1: $10; Tier 2: $60; Tier 3: $90

Up to 90 day supply renewable up to a year for maintenance/specialty meds.

 

 

Not covered

*H S A Plan covers deductible, then copay (except preventive meds) **Some medications are excluded and alternative medications are available, check with your physician

Contraceptive Coverage for 2023

(note: no changes from 2021)

Prescription Contraceptives

 

CPHL, WCM-PPO, H S A

 

In-Network

CPHL, WCM-PPO, H S A

 

Out of Network

Oral contraceptives,

Barrier methods

(i.e. diaphragm),

$0 copay for generic or single source brand ***

Contracted rate less the applicable copay

Over the Counter Contraceptives:

Condom, sponge, spermicide, Plan B and ella

(Prescription required)

 

 

Same as above for contraceptives

 

 

 

Same as above for contraceptives

 Contraceptives that are injectable or implantable continue to be covered under the Aetna medical plans as part of the
office visit

100%

 

Specific plan deductible, then coinsurance
 

 

***If not a generic or single source brand, refer to the above OptumRx tier schedule for the 2nd or 3rd tier copays. If your doctor determines that the generic or single source contraceptive would be medically inappropriate, they can prescribe a medically appropriate multisource contraceptive.

 

Home Delivery or On-Campus Pickup at Cornell Health's Pharmacy

Fill a 90 day supply of your-long term or maintenance medications through OptumRx’s Home Delivery or Cornell Health Pharmacy. Home Delivery: Let your doctor know that you have a home delivery prescription drug program and that you would like to have the maximum supply of medication (usually 90 days) plus refills for up to one year. You may mail your prescription(s) to OptumRx or ask your physician to fax it or send it electronically to OptumRx. Be sure to allow at least 14 days from the time OptumRx receives your prescription(s) for your order to arrive. 

Cornell Health Pharmacy: To participate, ask your clinician to “e-scribe” your 90-day prescription to the Cornell Health Pharmacy (listed as “Cornell – zip code 14853” in the Surescript network). When we receive your prescription, we will keep it on file until you contact us (607-255-6976 or myCornellHealth) to fill it for you. We do not auto-fill prescriptions.

Prior Authorization

Some medications are covered by your plan only for certain uses and require authorization before purchasing. The pharmacy will let you know if your health plan requires additional information. You or the pharmacy can then ask your doctor to call a special toll-free number. This call will initiate a review that typically takes 1 to 2 business days.

Once the review is complete, OptumRx will notify you and your doctor of the decision. You always have the right to appeal any decision.

OptumRx Mobile App

For easy on-the-go access to your personalized health information, download the mobile app. You'll need your member ID number to set up your account.

optum rx app logo

OptumRx Website

Create an account on the OptumRx website to check drug information and your coverage. Have your member ID card ready to create your account. There are many convenient tools on the site to help you manage your prescription drugs.

 

Specialty Pharmacy Prescriptions

If your treatment plan calls for specialty medications, you will fill your prescription exclusively through Optum Specialty Pharmacy (pdf). Optum Specialty Pharmacy is focused on providing you with the best possible care while you undergo specialty medication treatment. You will pay the applicable Home Delivery Copay. Optum Specialty Pharmacy can deliver your medication to your home or you can direct delivery to the Cornell Health Pharmacy on Cornell’s Ithaca Campus. (refer to the Home Delivery Section above). Optum Specialty Pharmacy offers highly personalized service for chronic and complex conditions such as multiple sclerosis, rheumatoid arthritis, cancer, and others. Member services is available Monday through Friday, 8:30 a.m. to 5:00 p.m. A clinician is always available, 24 hours a day, 7 days a week, for emergency on-call services. Call Optum Specialty Pharamcy at (844) 265-1761 or visit:  specialty.optumrx.com.

 

There may be additional limits on quantity or authorizations needed for medications you are taking. If you have questions about your prescription drug coverage, contact OptumRx Member Services at (866) 533-6977​ or you can find more information at https://www.optumrx.com/public/landing.