OptumRx is the pharmacy benefit manager for members of the Local Government Health Insurance Plan. If you have questions about your OptumRx prescription drug coverage, please call 1-844-785-1603.
2023 Prescription Drug List
- Check out the 2023 Formulary – the list of drugs covered by your plan.
- Click here to review the ACA Preventative Care Medications.
- Click here to review the Specialty Pharmacy Medications.
- Check out the 2023 OptumRx Planbook for more information.
- Ready to file for prescription drug reimbursement? View this guide for instructions!
2023 Pharmacy Benefits
Using tier 1 or preferred medications can help you pay your lowest out-of-pocket cost. Our health insurance plan has multiple tiers.
| Copay | Supply Limit | |
|---|---|---|
| Tier 1 Drugs, including all covered generic drugs | $15 copay | Non-maintenance 30-day supply Maintenance drugs 60-day supply, after an initial 30-day fill. |
| 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!
Pharmacy at your fingertips
Fast, easy and secure. The OptumRx.com website and app gives you the information you need to make the most of your pharmacy benefit.
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.
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. Check out the instructions on how to file for reimbursement by clicking here! Ready to file? Login to your account complete the claim form and submit it to OptumRx for your reimbursement. Note: Generic medications are not eligible for claim reimbursement.
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.
