Prescription Drug Benefits
The Health and Benefit Trust Fund offers prescription drug benefits to eligible participants. Prescription drug benefits include coverage for filling prescriptions at retail pharmacies and a mail-order prescription drug program.
The Prescription Drug Plan is administered by OptumRx. You can visit the OptumRx website at www.optumrx.com.
Find out more about your prescription drug benefits by clicking on the links below:
How the Prescription Drug Plan Works
The Local 94 Health and Benefit Trust Fund offers a Prescription Drug Plan that helps you pay for medication. Eligible participants receive benefits such as coverage for maintenance, or long-term, medications, the use of a mail-order pharmacy and the use of a nation-wide network of retail pharmacies. The Prescription Drug Plan is administered by OptumRx.
Eligibility and Enrollment
Learn more about eligibility and enrollment for all Health and Benefit Trust Fund plans.
Membership ID Card
When you become eligible to participate in the Health and Benefit Trust Fund Prescription Drug Plan, you receive a membership card from OptumRx. Your card has your member ID, group ID and important contact information. If you do not receive a card from OptumRx after becoming eligible or need to print a temporary ID card, visit OptumRx's website at www.optumrx.com or contact the Fund Office.
Prescription Drug Plan Network
Retail pharmacies - 30-day short term prescriptions
Your plan's retail pharmacy network has thousands of retail pharmacies - including national chains and most independent pharmacies. For a complete list of participating retail pharmacies, use the Pharmacy Locator tool on the OptumRx app at optumrx.com or call a customer service advocate at 855-295-9140, TTY 711.
CVS90 Saver Plus - Maintenance Medications
A maintenance prescription is typically taken on a regular basis to treat a chronic condition and will exceed two fills. If you exceed two fills on a specific prescription, your third fill must be purchased through the OptumRx Home Delivery or a retail CVS pharmacy only. If you are using the OptumRx Home Delivery Service you must download and fill out the OptumRx Mail Service Order Form.
Find a Network Pharmacy
To find a OptumRx network pharmacy in your area, visit the OptumRx website at www.optumrx. You must first register at the OptumRx website in order to use this service.
Prescription Drug Plan Covered Services
The Prescription Drug Plan covers many prescription drugs, including brand-name and generic medications. Maintenance drugs, or drugs taken for chronic conditions, are also covered under the Plan.
A complete list of covered prescription drugs is found in the OptumRx Formulary. A formulary contains prescription drugs that the Plan Benefit Manager (in this case OptumRx) and prescription drug manufacturers have agreed to sell at discounted prices.
- You can view the OptumRx formulary at www.optumrx. Check to see if any medication you currently take is on the formulary. If your medication is not on the formulary, speak with your doctor right away.
Prescription Drug Costs
As a participant in the Prescription Drug Plan, you share the cost of your prescription medications with the Health and Benefit Trust Fund.
When filling a prescription, you pay a copayment, or a small, one-time fee. The amount of your copayment depends on the amount of medication prescribed and whether your prescription is for a generic drug, a brand-name drug found on the formulary or a brand-name drug not found on the formulary.
Generic versus Brand-Name
There is very little difference between generic and brand-name prescription drugs. Drug companies that manufacture brand-name drugs hold a patent for their medications.
When the patent expires, other companies manufacture the same drug, but these are called generic drugs. The FDA makes sure the generic medicine has the same clinical effect and is just as safe as the brand-name product.
Generic drugs cost substantially less to manufacture than brand-name drugs, meaning they cost less for you to purchase.
Ask your doctor if a generic alternative can replace your brand-name prescriptions.
Prescription Drug Claims
Typically, an In-Network provider files your prescription drug claims for you. However, if you have to file your own claim, you can download and fill out the OptumRx Reimbursement Claim Form (PDF). You must file your claim within one year of the date that the charges are incurred.
Visit OptumRx Member Website
OptumRx's member website lets you order prescriptions online and learn about your medication. The site is available 24/7. At OptumRx’s member website you can:
- Order and refill your prescriptions online
- Find a network retail pharmacy
- Learn about different prescription drugs
- Chat with a licensed pharmacist and ask questions
- Look up your prescription drug claim history
To access the site, visit www.optumrx.com. To register, use your member ID found on your OptumRx ID card.
More Information
For more information on how the Prescription Plan works and what OptumRx covers contact OptumRx directly at 855-295-9140 or log onto www.optumrx.com. You may also visit the SPD for Actives and Retirees in the Commercial Division or the SPD for Actives and Retirees in the School Division or contact the Fund Office.
FAQs
How do I add my newborn child to my plan?
You must provide the Fund Office with a copy of the child’s birth certificate within 90 days of birth to enroll your child with the applicable date (child’s birthdate). If you fail to do so, within the applicable 90-day period, dependent coverage will not be available under the Plan for your new dependent child until the first of the month following the date in which you provide the Fund Office with the required documentation or any other verifying information requested. A Coordination of Benefits Form (COB) must be completed if your child has other coverage. You should also visit the Life Events page on this site to see what you need to do for your other benefits.