Welcome to Optum Rx
Your pharmacy network
For medications you take regularly, you can also use Optum Home Delivery Pharmacy.
Your prescription drug benefits
Working with your benefits plan sponsor, OptumRx provides convenient and flexible options for the prescription drugs you and your family may need. We are here to guide you through the open enrollment process and to help you understand your plan options, so that you can save time and money when your benefits plan starts.
Pharmacy Benefits
Pharmacy benefits are managed by BlueCross and our partner, OptumRx. The tools available here can help Continental employees and dependents with locating a network pharmacy. You can also find the classification/tier level and estimated cost of your prescription based on the medical option you select.
Also, all members can sign into My Health Toolkit at www.southcarolinablues.com to view personalized information about your pharmacy benefits.
Pharmacy Network
There are almost 70,000 pharmacies in the network. All major chains, as well as many independent drug stores, are included. Always make sure your pharmacy is part of our network before you have your prescriptions filled. Use the Find a network pharmacy link at the top of this page to search for a participating pharmacy.
Premium Formulary
Your prescription drug benefit is based on a list of covered drugs called the Premium Formulary. A group of network doctors and pharmacists chooses the drugs for the formulary based on their effectiveness, safety and value. If you want to save the most on your drug costs, ask your doctor if a generic or preferred brand-name drug is right for you.
The formulary is subject to change a few times a year without notice. Use the searchable tools at the top of the page to find out more about how prescription drugs are covered under your new plan:
Drug Price Tool: Search for the estimated price of a drug based on which benefit plan you select, and compare the costs between pharmacies.
Prescription Drug List: Your pharmacy benefit is based on tiers. Tiers are the different cost levels you pay for medications such as generics (Tier 1), preferred brands (Tier 2), non-preferred brands (Tier 3). Use this tool to find out more about what copay tier a drug is on, if it’s a specialty drug and whether it has any limitations such as Prior Authorization, Step Therapy or Quantity Management.
Specialty Drugs
Specialty prescription drugs treat complex or chronic medical conditions. These drugs are usually dispensed by pharmacies that specialize in specialty drugs.
Optum Specialty Pharmacy is your health plan’s preferred specialty pharmacy. Any drug on the specialty drug list must be purchased at Optum Specialty Pharmacy for the charges to be covered under your pharmacy benefit.
For questions, please call the specialty pharmacy at 1-877-259-9428 . If you have a new prescription for a specialty drug, a representative will help you get set up and will help you with your first fill.
Specialty copay cards: If you use a specialty copay card or coupon to reduce your out-of-pocket cost for a specialty drug, please inform the specialty pharmacy during your first call. Also, the portion of your copay paid by the manufacturer will not accumulate towards your deductible or out of pocket maximums.
Prior Authorization
If you are prescribed a medication that is included in our Prior Authorization program, your doctor must request and receive prior approval before your plan will cover that drug. Use the Prescription Drug List tool at the top of the page to see if a specific drug requires Prior Authorization.
Quantity Management
Quantity Management limits the amount of certain medications that we cover. For most medications, your benefit will only cover a set amount within a set time frame. Use the Prescription Drug List tool at the top of the page to see if a specific drug has a quantity limit.
Step Therapy
Several medical conditions can be treated using a variety of drugs. In some cases, there is a very large difference in cost of the medications. Many people find the more cost-effective medications work just as well for them. Step Therapy requires members to try more cost-effective prescription drugs before trying (or "stepping up to") more expensive ones. If you have not tried a more cost-effective alternative in the recent past, you must do so, or your doctor must request an exception before you will have coverage under your plan. Use the Prescription Drug List tool at the top of the page to see if a specific drug has a Step Therapy requirement.
Opioid Management
To help combat the ongoing national opioid crisis, we have implemented a program based on U. S. Centers for Disease Control and Prevention (CDC) guidelines. It consists of daily quantity limits specific to each covered opioid drug and prior authorization requirements for certain prescribing situations. There are also limitations on the amount of opioid medication we will cover for first-time prescriptions.