The OptumRx retail pharmacy network includes more than 68,000 participating pharmacies nationwide, including national pharmacy chains and independent community pharmacies.
You can purchase a prescription 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 a networking pharmacy.
ID Card
You will receive an OptumRx ID card in the mail following your enrollment.
Replacement Card: If you need a replacement, download your temporary ID or order a new one online.
- Sign in to your account or register as a first-time user.
- Once at the home page click:> Benefits and Claims> ID Card
- Print card or enter the quantity desired (1-9)
- OptumRx will mail physical ID cards directly to you.
Purchasing Medication
Please use your OptumRx prescription insurance ID card (not your Aetna ID card) for all your prescription drug purchases. Aetna is only for 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, along with the following:
- Employee ID or SSN#
- BIN: 610011
- PCN: IRX
- RxGroup: PURCORNEL
If you do not provide this information, you will pay more since OptumRx will only reimburse you the contracted rate less the applicable copay. In addition, you'll need to submit a claim form to OptumRx to receive reimbursement.
How To Submit A Claim
(note: reimbursement rate is contracted rate less applicable copayment):
- Online:
- 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
2025 Prescription Drug Plan Co-Pays
- Tier One: Covered generic drugs
- Tier Two: Covered preferred brand-name drugs
- Tier Three: Covered brand-name drugs**
| 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 copayUp to 30 day supply |
|---|
Home Delivery * 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 Obtain up to 90 day supply by paying 60 day supply copayment renewable up to a year for maintenance/specialty meds. | Not covered |
|---|
Aetna HDHP with HSA Plan applies deductible, then copay (except preventive meds)
*Using home delivery saves one month's copayment for specialty and long-term maintenance medications
**Some medications are excluded and alternative medications are available, check with your physician
Contraceptive Coverage for 2025
Prescription Contraceptives | CPHL, WCM-PPO, HSA In-Network | CPHL, WCM-PPO, HSA 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 theoffice visit | 100% | Specific plan deductible, then coinsurance |
|---|
***If a prescription is 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. You may pay less for your medication with a 3-month supply.
Home Delivery: Let your doctor know that you have a home delivery prescription drug program and you would like 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 when 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). Cornell Health does not auto-fill medications. So once the prescription is received, they will keep it on file until you contact them to fill it (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 specific uses and require authorization before purchasing. The pharmacy will let you know if your health plan requires additional information. If required, you or the pharmacy can ask your doctor to call a dedicated toll-free number to initiate a review. Typically the review takes 1 to 2 business days to complete. OptumRx will notify you and your doctor of the decision. You always have the right to appeal any adverse decision.
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 provides 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 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 many 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 Pharmacy at (844) 265-1761 or visit: specialty.optumrx.com.
If you have questions about your prescription drug coverage, including quantity limits or prior authorizations, call OptumRx Member Services at (866) 533-6977 or visit https://www.optumrx.com/public/landing.
