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Endowed Prescription Drug Coverage

If you participate in any of the endowed self-insured medical plans, you are automatically covered by the OptumRx prescription drug program.

Optum Rx logo

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.


Forms & Reference

Contact OptumRx

Also see: Covid-19 Benefits Info   


Resources

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):

  • 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

2024 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 2024

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.


While every attempt has been made to ensure the accuracy of this Summary, in the event of any discrepancy the Summary Plan Description and Plan Document will prevail.