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.
- 2024 OptumRx Benefit Booklet
- 2024 Prescription Drug Formulary
- ACA Preventative Care Medication List
- Specialty Pharmacy Medication List
2024 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: Generics | $15 copay or the cost of the medication, whichever is less. |
Up to a 30-day supply Up to a 60-day supply after initial 30 day fill (maintenance medications) |
|
Tier 2: Preferred Drugs |
Member must pay 100% of the cost of the drug and file for 80% reimbursement after $200 deductible has been met. | Up to a 90-day supply |
| Tier 3: Non-Preferred Drugs | Member must pay 100% of the cost of the drug and file for 80% reimbursement after $200 deductible has been met. | Up to a 90-day supply |
| Tier 4 | For certain high-cost drugs, members are responsible for 20% coinsurance at the point-of-sale. Plan covers medication at 80% |
Days supply varied by medication Refer to the formulary booklet for covered medications |
Pharmacy at your fingertips
The OptumRX website and app gives you the information you need to make the most of your pharmacy benefit.
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.
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 OptumRX Specialty Pharmacy. Call 1-855-427-4682 or visit specialty.optumrx.com for more information.
OptumRx Drug Card
To view and print your OptumRx card, sign in to your OptumRx account through the mobile app or through the member portal.
