2024 Premium 4-Tier prescription drug coverage
Harvard Pilgrim Health Care works with OptumRx for pharmacy benefit management services.
Find an OptumRx network pharmacy near you. See what drugs your plan covers, and if you have a deductible for prescriptions, use the Drug Pricing Tool to learn how much your drugs may cost before you reach the annual deductible.
Buying your prescriptions
Check to see if the pharmacy you use participates in the OptumRx network. You can also use OptumRx home delivery for 90-day supplies of medications you take regularly for conditions such as heart disease, diabetes or depression (standard shipping is free).*
Call 1-855-258-1561 to get started, or log in to your Harvard Pilgrim member account and click "Check drug coverage & costs." Have your Harvard Pilgrim ID number, prescription number(s) and credit card information ready. If you have a deductible for prescriptions, use the Drug Pricing Tool to learn how much your drugs may cost before you reach the annual deductible.
*Specialty medications, which are prescribed for treating complex conditions such as hepatitis C, multiple sclerosis or rheumatoid arthritis, are provided through Optum Specialty Pharmacy. They're typically delivered directly to your home.
Your prescription drug benefits
Find out which drugs are covered on our Premium 4-Tier Plan.
Additional Information
Some hospitals and physician practices have lists of drugs that they prefer their doctors to prescribe. (Such a list might be called a "Drug Formulary" or a "Preferred Drug List.") Hospital or physician drug lists do not affect the coverage provided by Harvard Pilgrim and its affiliated health plans. Harvard Pilgrim's prescription coverage is generally explained in the Prescription Drug Brochure for the benefit plan in which a member is enrolled.
Additional resources to help you understand your prescription drug benefits.
Optum Home Delivery Mail Order Form (PDF)
Paper Claim Reimbursement Form (PDF)
Exception Process – 2024 Premium 4-Tier | OptumRx
Have a Question?
For questions or concerns about your pharmacy benefits (i.e. cost sharing, claims, etc.), please call the number on the back of your member ID card. For current members, send a secure email to Member Services through your Harvard Pilgrim member account.
If this is an emergency, dial 911.