Human Resources

Endowed Prescription Drug Coverage

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.

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

2018 Prescription Drug Plan Co-Pays

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 2018

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:

Female condom, sponge, spermicide, Plan B and ella

(Prescription required)

 

 

Same as above for contraceptives

 

 

 

Same as above for contraceptives

    ***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.

    Note: Contraceptives that are injectable or implantable continue to be covered under the Aetna medical plans as part of the office visit. Under CPHL, WCM-PPO, H S A, the visit is covered at 100% in-network.

    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: Ask your clinician to “escribe” your 90-day prescription to the Cornell Health Pharmacy (listed as “Cornell – zip code 14853” in the Surescript network). You can indicate when you would like to pick up your prescription by logging in to Cornell Health's secure patient portal (mygannett.gannett.cornell.edu) and selecting Messages and Pharmacy Services > New Message > Ask a Pharmacist. You will receive a message from the pharmacy when your prescription is ready for pick-up. Click here for more details about the Cornell Health Pharmacy pickup option.

    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 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.

    Mobile App: For easy on-the-go access to your personalized health information, download the Mobile app (pdf). You'll need your member ID number to set up your account.

    Drug Lookup: provides detailed information about uses for a medication, dosages, interactions and side effects. Select "Tools & Resources" (on the left side of the screen) and then "Drug Lookup" (once you've created an account, these options will also appear in the center of your personalized page). Follow the step-by-step instructions. At the top of the final information page, you'll have options to save to your OptumRx journal, print, and look up pricing.

    Price & Save: shows tier coverage, what you can expect to pay for a medication, and helps you locate the nearest participating pharmacy.

    Formulary: (located in "Tools & Resources > Forma & Documents") is a listing of medications covered by your plan, showing whether a drug is generic, preferred, or non-preferred.

    Preventive Drug List: (located in "Tools & Resources > Forms & Documents") is defined as drugs prescribed to prevent the occurrence of a chronic disease or condition for those individuals with risk factors, or to prevent the recurrence of a disease or condition. Some examples of the medications listed are for high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, and heart disease. This list shows what drugs are covered, and whether they're generic, preferred, or non-preferred.

    Meds Journal: (located under "Manage Accounts") is a convenient place to track your prescriptions as well as over-the-counter medications and supplements. You can keep notes and print a copy for your records or to share with family members or caregivers.

    Specialty Pharmacy Prescriptions

    If your treatment plan calls for specialty medications, you will fill your prescription exclusively through BriovaRx Specialty Pharmacy. Briova is a pharmacy that is focused on providing you with the best possible care while you undergo specialty medication treatment. You will pay the applicable Home Delivery Copay. Briova can deliver your medication to your home or you can ask Briova to direct the delivery to the Cornell Health Pharmacy on Cornell’s Ithaca Campus. (refer to the Home Delivery Section above). BriovaRx offers highly personalized service for chronic and complex conditions such as multiple sclerosis, rheumatoid arthritis, cancer, and others. Member services is available for Briova, 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 BriovaRx at (855) 427-4682 or visit: www.BriovaRx.com

     

    There may be additional limits on quantity or authorizations needed for medications you are taking.  On or after January 1, 2018, you can find more information at https://www.optumrx.com/public/landing

    If you have questions about your prescription drug coverage, contact OptumRx Member Services at 866-533-6977.