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
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.
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
The OptumRx App makes the online pharmacy experience as simple as possible. You can easily:
- Refill or renew a home delivery prescription
- Transfer a retail prescription to home delivery
- Find drug prices and lower-cost options
- View your prescription claim history or order status
- Locate a pharmacy
- Access your ID card
- Set up refill reminders
- Track your order
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
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.
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)
Value Pharmacy Network
The OptumRx Value Pharmacy Network lets you fill prescriptions at thousands of retail pharmacies nationwide. That way you are assured of finding a pharmacy close to home or work.
The Value Pharmacy network has more than 35,000 participating pharmacies. Major drug store chains, mass retailers and supermarkets make up a large part of the Value Network. Here are a few of the popular chains in the network:
- Major drug stores including Walgreens and Rite Aid
- Mass retailers including Walmart
- Supermarkers including Kroger and Meijer
The Value Network also includes OptumRx home delivery, which allows you to get 90-day supplies of your medications delivered to your home, with free standard shipping.
However, some pharmacies such as CVS and Costco are not in the Value Network.
What happens if I try to fill a prescription at a non-value network pharmacy?
Non-network claims will be denied and you may have to pay the full retail price for your medication. To take advantage of your prescription drug benefit, transfer your prescriptions to a participating Value Network pharmacy.
Find a Value Network pharmacy near you:
You have three ways to quickly and easily find a nearby Value Network pharmacy:
Use the online Locate a Pharmacy tool at optumrx.com
- Contact OptumRx Customer Service by calling the toll-free number: 1.800.797.9791
- Download the OptumRx App to search on your smartphone or tablet
How do you transfer prescriptions to a Value Network pharmacy?
Transferring prescriptions to a new pharmacy is easy. Simply provide your medication bottle or prescription information to your new pharmacy. The pharmacy will either transfer any refill(s) on your current prescription or get a new prescription for you by contacting your doctor.
If you have questions, please call the customer service number: 1.800.797.9791