Prescription Drug Benefits

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OptumRx is the pharmacy benefit manager for members of the Local Government Health Insurance Plan.

2020 Pharmacy Benefits

To see a list of covered drugs under the LGHIP, click here.

Copay Supply Limit
Tier 1 Drugs, including all covered generic drugs $10 copay Non-maintenance 30-day supply Maintenance drugs 60-day supply
Tier 2 and 3 Drugs Member must pay 100% of the cost of the drug and file for 80% reimbursement after $200 deductible has been met. 90-day supply
Specialty Member must pay 100% of the cost of the drug and file for 80% reimbursement after $200 deductible has been met. 30-day supply
Point-of-Sale Exception List For certain high-cost drugs, members are responsible for 20% coinsurance at the point-of-sale. Supply amount is dependent upon drug

OptumRx.com is a fast, easy and secure way to get the information you need to make the most of your pharmacy benefit. Set up your optumrx.com account today!

OptumRx Member Portal

Create your account with OptumRx today! Visit the OptumRx member portal for easy access to:

  • Manage all your prescriptions on a single dashboard
  • Update your information and complete your health profile
  • Compare prices at local pharmacies
  • Find your lowest prescription cost
  • Locate your pharmacy and get driving directions
  • Keep track of your health history
  • Learn more about your drugs
  • Take it all with you through the mobile app
  • Manage prescriptions for your dependents and family members, where appropriate.

2020 Prescription Drug List

  • Check out the 2020 formulary – the list of drugs covered by your plan.
  • Click here to review the ACA Preventative Care Medications.

Prescription Drug Reimbursement

For name-brand prescriptions, you will need to pay 100% out-of-pocket at the point-of-sale, then file for your 80% reimbursement (subject to your $200 deductible) with OptumRx. Complete the claim form, and submit it to OptumRx for your reimbursement.

To request reimbursement for drug claims incurred in 2019, click here.

24/7 Support

Pharmacists are available 24 hours a day, 7 days a week to answer questions about your medications or prescription benefits. You can call 1-844-785-1603 any time you have questions.

Prior Authorizations

A prior authorization is an approval you or your doctor obtain before you can get coverage for certain medications. The review process helps make sure the medication you’re taking is appropriate and effective for your condition. Check the prescription drug list, also known as the formulary, to find out if a medication you take requires a prior authorization.

Specialty Pharmacy

Do you take a specialty medication? You can fill your specialty medications at Optum Specialty Pharmacy. Call 1-855-427-4682 or visit specialty.optumrx.com for more information.

OptumRx Drug Card

Need another OptumRx card? Your new OptumRx insurance card is at your fingertips! To view and print your OptumRx card, sign in to your OptumRx account through the mobile app or through the member portal.

OptumRx is the pharmacy benefits manager for the Local Government Health Insurance Plan.

Yes. Your prescriptions can be filled at a large network of retail pharmacies, including large national chains and many local pharmacies.

The formulary is a list of commonly prescribed medications. It also:

  • Identifies medications for certain conditions and organizes them into cost levels called tiers
  • Lets you know if any medications require prior authorization or step therapy, which may affect how they are covered and how much they will cost
  • Includes information about medications that may have quantity/supply limits or are considered a specialty medication

To learn if a specific medication is covered, check your formulary with the OptumRx app or online. You can also find out if you need to do anything before filling your prescriptions.

You will receive a letter if you need to take any action before your first fill.

You may access your OptumRx drug card through the OptumRx mobile app, through the member portal at www.OptumRx.com, or by calling 1-844-785-1603.

Yes. Pharmacy copays count toward your annual out-of-pocket maximum.

No. Copays do not count toward annual deductibles. Only when you purchase a name brand drug and you pay for the cost at 100% then file for your reimbursement with OptumRx, does it count toward your deductible. If you pay for a name brand drug and do not file it with OptumRx, this purchase will not count toward your deductible.


Specialty medications are for conditions such as cancer, multiple sclerosis and rheumatoid arthritis. They can be injectable, taken by mouth, or inhaled. They also:

  • May require ongoing clinical oversight and additional education for best management
  • Have unique storage or shipping requirements
  • May not be available at retail pharmacies

A health care professional makes sure the medication you’re taking is:

  • Working effectively
  • The best or right dose for your condition
  • Not causing harmful side effects

You can fill your prescription at Optum® Specialty Pharmacy. Optum’s patient care coordinators and pharmacists are trained to understand your special therapy needs.