Prescription Drugs
What You Need to Know
When you need a prescription filled, your most convenient option will be the SHS Pharmacy, where your copay will typically be lowest.
Optum Rx 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 Optum Rx nationwide retail pharmacy network versus an out-of-network pharmacy.
If you have your prescription filled at a pharmacy outside the SHS, 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 [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 will pay 100% of your 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 Riverside Prescription Drug Plan booklet [PDF].
Your annual limit on out-of-pocket costs includes your prescription drug copays and medical costs.
SHS Pharmacy
Family: $9,000
Copays below are for a 30-day supply.
For more information, visit the SHS Pharmacy website.
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.