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.

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 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 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 Diego Prescription Drug Plan booklet [PDF].

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

SHS Pharmacy

You Pay
Annual Limit on Your Out-of-Pocket Costs (pharmacy only)
Individual: $1,000

Copays below are for a 30-day supply.

Copay
Generic Drugs
$5 copay
Brand-Name Formulary Drugs
$25 copay
Brand-Name Non-Formulary Drugs
$40 copay
Specialty Medications
10% coinsurance up to $100

For more information, visit the SHS Pharmacy website.

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.

UC Family costs count toward the lower SHS Pharmacy annual out-of-pocket limit. It’s another way you save when you use UC Family providers.

You Pay
Annual Limit on Your Out-of-Pocket Costs (pharmacy only)1
Individual: $1,000
Family: $2,000

Copays below are for a 30-day supply.

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

1. What you pay out of pocket for prescription drugs contributes to your medical annual limit on out-of-pocket costs.

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 OptumRx prescription drug claim form for reimbursement. You can also download a PDF of the OptumRx 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.

You Pay
Annual Limit on Your Out-of-Pocket Costs (combined with medical costs)
Individual: $5,000
Family: $7,000

Copays below are for a 30-day supply.

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

OptumRx

Prescription drug plan benefits
(844) 265-1879