Prescription Drug Program

Mail Order Program - Optum RX

A mail-order program is available with HealthSelect and all HMO coverage. Through this program, up to a 90-day supply of a prescription can be obtained (3-month payment for 90-day supply).

Cost to Employee

A $50 deductible applies to each member per plan year (January 1 - December 31). After deductible is met, member will be charged the appropriate co-payment.

Table 1: Prescription Drug Cost to Employee
	Tier 1	Tier 2	Tier 3
Participating retail non-maintenance	$10 up to a 30-day supply	$35 up to a 30-day supply if generic is not available*	$60 up to a 30-day supply if generic is not available*
Participating retail maintenance	$10 up to a 30-day supply	$45 up to a 30-day supply if generic is not available*	$75 up to a 30-day supply if generic is not available*
All carrier mail order programs	$20 For 31-60 day supply $30 For 61-90 day supply	$70 For 31-60 day supply if generic is not available* $105 For 61-90 day supply if generic is not available*	$120 For 31-60 day supply if generic is not available* $180 For 61-90 day supply if generic is not available*
HealthSelect Extended Days Supply (EDS) Pharmacy Network	$20 For 31-60 day supply $30 For 61-90 day supply	$70 For 31-60 day supply if generic is not available* $105 For 61-90 day supply if generic is not available*	$120 For 31-60 day supply if generic is not available* $180 For 61-90 day supply if generic is not available*

*If generic is available and you choose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.

Page updated: 09/08/2021