Prescription Drugs
What You Need to Know
Optum Rx administers your pharmacy benefit, so when you need a prescription filled, you’ll typically pay less when you use a retail pharmacy in the Optum Rx nationwide network. Just show your Anthem member ID card.
You can also refill prescriptions by mail through Optum Rx Home Delivery.
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 [PDF] is the list of medications that UC SHIP covers.
What you pay for prescription drug costs counts toward your combined medical and pharmacy annual out-of-pocket limit. Once your costs reach that limit, UC SHIP steps in to pay 100% of your medical and pharmacy costs for the remainder of the year.
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 Merced Prescription Drug Plan booklet [PDF].
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 Optum Rx network, including CVS and Walgreens. To find a list of Optum Rx pharmacies near you, sign in to the Optum Rx website.
Family: $9,000
Copays below are for a 30-day supply.
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 the online Optum Rx prescription drug claim form for reimbursement. You can also download a PDF of the Optum Rx prescription drug claim form [PDF]. 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.
Family: $18,000
Copays below are for a 30-day supply.
1. You will also pay any amount above the Optum Rx 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 Optum Rx 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.