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 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 San Diego Prescription Drug Plan booklet [PDF].

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

SHS Pharmacy

Annual Limit on Your Out-of-Pocket Costs (Costs accumulate together with network provider costs.)
You Pay
Individual: $4,500
Family: $9,000

Copays below are for a 30-day supply.

Generic Drugs
Brand-Name Formulary Drugs
Brand-Name Non-Formulary Drugs
Specialty Medications
Copay
$5 copay
$25 copay
$40 copay
10% coinsurance up to $250

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.

Annual Limit on Your Out-of-Pocket Costs (Costs accumulate together with SHS costs.)
You Pay
Individual: $4,500
Family: $9,000

Copays below are for a 30-day supply.

Generic Drugs
Brand-Name Formulary Drugs
Brand-Name Non-Formulary Drugs
Specialty Medications
Copay
$10 copay
$40 copay
$100 copay
10% coinsurance up to $250

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.

Annual Limit on Your Out-of-Pocket Costs (combined out-of-network medical and pharmacy costs)
You Pay
Individual: $9,000
Family: $18,000

Copays below are for a 30-day supply.

Generic Drugs
Brand-Name Formulary Drugs
Brand-Name Non-Formulary Drugs
Specialty Medications
Copay
$10 copay1
$40 copay1
$100 copay1
10% coinsurance1 up to $250
1. You will also pay any amount above the Optum Rx maximum allowed amount.

Contacts

Student Health Services (SHS)

Your first stop for care on campus
Main number/appointments: (858) 534-8089
Counseling and Psychological Services (CAPS): (858) 534-3755
SHS website
Library Walk, west of the Price Center, south of Geisel Library

Optum Rx

Prescription drug plan benefits
(844) 265-1879