Prescription Drugs

What You Need to Know

When you need a prescription filled, your most convenient option will be the Student Health Services Pharmacy, where your copay will typically be lowest.

OptumRx administers your pharmacy benefit, so when you’re away from campus and need a prescription filled, you’ll usually pay less when you use a retail pharmacy in the OptumRx nationwide retail pharmacy network versus an out-of-network pharmacy.

If you have your prescription filled at a pharmacy outside the SHC, be sure you show your Anthem member ID card.

How Your Prescription Drug Coverage Works

What you pay for your prescription (your copay) is based on medication type: generic, brand-name formulary, brand-name non-formulary, or specialty. The formulary is the list of medications that UC SHIP covers.

What you pay for prescription drug costs counts toward your annual out-of-pocket limit. Once your costs reach that limit, UC SHIP steps in to pay 100% of your pharmacy costs.

Oral Contraceptives Are Free

You’ll pay nothing for FDA-approved generic oral contraceptives and brand-name oral contraceptives (when there’s no generic equivalent). Coverage is for a 180-day supply.

You’ll find coverage details below. For more information, review the UC San Francisco Prescription Drug Plan booklet.

Your annual limit on out-of-pocket costs includes your prescription drug copays and medical costs.

Network Pharmacies

Network pharmacies include participating UC pharmacies and retail pharmacies in the OptumRx network, including CVS and Walgreens. To find a list of OptumRx pharmacies near you, sign in to the OptumRx website.

Coverage
Annual Limit on Your Out-of-Pocket Costs
You Pay
Individual: $3,000
Family: $6,000

Copays below are for a 30-day supply.

Drug Tier
Generic Drugs
Brand-Name Formulary Drugs
Brand-Name Non-Formulary Drugs
Specialty Medications
Copay
$5 copay
$25 copay
$40 copay
$40 copay
Out-of-Network Pharmacies

When you fill your prescription at an out-of-network pharmacy, you will pay the entire amount of the prescription and then submit an OptumRx prescription drug claim form [PDF] for reimbursement. The pharmacist must complete and sign the claim form to ensure the claim is properly processed. Your reimbursement could be less than what you paid for the medication.

Coverage
Annual Limit on Your Out-of-Pocket Costs
You Pay
Individual: $6,000
Family: $12,000

Copays below are for a 30-day supply.

Drug Tier
Generic Drugs
Brand-Name Formulary Drugs
Brand-Name Non-Formulary Drugs
Specialty Medications
Copay
$5 copay1
$25 copay1
$40 copay1
$40 copay1

1. You will also pay any amount above the OptumRx maximum allowed amount.

Mail Order

For up to a 90-day supply of medications you take regularly, you can save by filling your prescription through OptumRx Home Delivery.

For order forms and the patient profile questionnaire you’ll need to submit with your first order, call (844) 265-1879.

Copays below are for a 90-day supply.

Drug Tier
Generic Drugs
Brand-Name Formulary Drugs
Brand-Name Non-Formulary Drugs
Copay
$15 copay
$75 copay
$120 copay