Prescription Drugs
Effective July 1, 2025
The administration of the prescription drug program will transition away from OptumRX to Anthem/CarelonRX. Please note that CarelonRx, the pharmacy division of Anthem, will be referenced alongside Anthem throughout the transition.
To meet its fiduciary responsibility to the Health Plan, the Archdiocese of Cincinnati (AOC) benefits department issued a Request for Proposal (RFP) to potential pharmacy program administrators. Following a thorough review, it was determined that Anthem/CarelonRX is the best choice to manage our pharmacy benefit, offering the most cost-effective and clinically beneficial options, along with the best outcomes for members.
The benefit and copay structure of the pharmacy plan will remain unchanged. However, there will be adjustments to the list of covered drugs which may move some medications to a different tier. For a majority of members this will result in a lower copay. If any of your prescriptions are impacted by these changes, you will be notified directly by Anthem or your pharmacy.
Major regional retail pharmacies used by our members are a part of the Anthem network so you can continue to go to the pharmacy of your choice. Members taking specialty medications will transition to Anthem’s Specialty Pharmacy, BioPlus, and members using Home Delivery will have access to CarelonRx home delivery.
Starting in mid-April, you will begin receiving ongoing detailed communications from the AOC benefits department and Anthem.
In the meantime, we’d like to share some key information:
- You will be able to access both your medical and pharmacy benefit information on the same platform via Anthem.com or the FREE Sidney Mobile App on your smartphone.
- Your medical and pharmacy benefit will be combined into one card under Anthem.
- All enrolled members will receive a new ID card before July 1, 2025.
Click here for the Anthem/CarelonRx Q&A
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Prior to July 1, 2025
The Archdiocese of Cincinnati prescription drug benefit is administered through OptumRx, it is separate from the Anthem medical benefit
and is accessed using an OptumRx ID card.
The Archdiocese of Cincinnati prescription drug benefit features the OptumRx Value Network. This Value Network is composed of approximately 35,000 retail pharmacy locations including Walgreens, Kroger, Meijer, Rite Aid & Walmart. Prescriptions should be filled at one of the pharmacies in the Value Network. Learn more
Note: Retail 90 day prescriptions may only be filled at Kroger pharmacies.
Creditable Coverage Notice
The Archdiocese of Cincinnati Health Plan has determined that the prescription drug coverage offered by OptumRx is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage.
Download the Certificate of Creditable Coverage for Prescription Drug Notice
Generic Drugs
Generic drugs must be dispensed when available. If member prefers to obtain the non-formulary brand product, member will pay generic copay PLUS the difference in cost between the brand and the generic product.
If there is medical justification for the use of brand vs. generic, the physician may call in a request for prior authorization to be reviewed by the Prior Authorization department.
Formulary brand refers to drugs that are not yet available as a generic.Non-formulary brand refers to the brand product for drugs that are available as a generic.Lost Prescription Drug ID Card
If you lose your OptumRx ID card, you can request a new one and print out a temporary ID card online by registering at OptumRx or by calling OptumRX customer service at 800.797.9791.
OptumRx App
The OptumRx App makes the online pharmacy experience as simple as possible. You can easily:
Refill or renew a home delivery prescriptionTransfer a retail prescription to home deliveryFind drug prices and lower-cost optionsView your prescription claim history or order statusLocate a pharmacyAccess your ID cardSet up refill remindersTrack your orderOptumRx Website
Register on OptumRx website to:
View your claim history
Check status of mail orders
Find network retail pharmacies
Search generic and meds
Refill scripts through mail service pharmacy
Request replacement ID Card
Prior Authorization
Your prescription drug plan requires prior authorization on certain medications. Prior authorization helps ensure select medications are prescribed according to FDA guidelines. If you are prescribed one of the medications that require prior authorization, you will be notified after you fill your first prescription. At that time, if you wish to keep using your medication, it must be pre-approved before your benefit plan will continue to cover it.
Prior Authorization Process
Your doctor can start the prior authorization review process by contacting the OptumRx Prior Authorization department at 1.800.711.4555. A pharmacy technician then works with your doctor to get the information needed for the review. Once OptumRx receives a completed prior authorization form from your doctor, they will conduct a detailed clinical review within three business days. OptumRx will then send you and your doctor a letter regarding the prior authorization decision.
Important: The information needed for the prior authorization review must be submitted to OptumRx by your doctor.
Specialty Pharmacy
If you are prescribed specialty drugs the Optum Specialty Pharmacy will be your specialty pharmacy. This specialty pharmacy partner will do more than just fill your prescriptions. You and your prescriber will be assigned a team to support you throughout the course of your specialty medication therapy.
To help you take full advantage of your enhanced specialty pharmacy program please note:
Whether your specialty medication is oral or injectable, or your caregiver, doctor, or you administer it, Optum Specialty Pharmacy can deliver your order to your physician’s office or to your home. Shipping is at no charge to you.
Your plan will cover up to a 30-day supply of your specialty medications at your plan’s copayment for a 30-day supply of specialty medications.
If you have questions, please contact Customer Service at 1.800.797.9791.
Summary of Benefits and Coverage (SBC)
The Summary of Benefits and Coverage (SBC) document shows you how you and the plan share the cost of covered pharmacy services.
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