Prescription Benefits
For your pharmacy needs.
For your pharmacy needs.
In-Network
Retail (30-Day Supply)1
Retail & Mail Order (90-Day Supply)1
Generic
$10 copay ($10 max)
$25 copay ($25 max)
Formulary Brand
30% coinsurance
($35 min/$125 max)
30% coinsurance
($70 min/$250 max)
Non-Formulary Brand
50% coinsurance
($50 min/$150 max)
50% coinsurance
($100 min/$300 max)
Specialty
Not covered
20% coinsurance
(30-day max supply)
When you enroll in a UnitedHealthcare (UHC) medical plan or the Surest Copay Plan, you are automatically enrolled in the Optum Rx Pharmacy Benefit. This coverage includes retail, specialty, and mail-order prescriptions.
Optum Rx uses Price Edge to help lower your prescription costs. When you fill a prescription at an in-network pharmacy and present your pharmacy ID card, the program automatically applies any available discounts—no extra steps required.
UHC PPO Plan:
Prescription drug costs do not apply to the medical deductible and there is no separate prescription drug deductible. However, prescription drug costs do count toward a separate out-of-pocket (OOP) maximum of:·
Surest Copay Plan:
There is no separate prescription drug deductible and prescription drug costs apply toward the combined medical and pharmacy out-of-pocket maximums.
Enhanced & Base CDHP Plans:
Prescription drug costs apply toward both the combined medical and pharmacy deductible and out-of-pocket maximum. However, certain preventive medications are covered before the deductible is met. For these medications, you pay only the applicable copay or coinsurance. This defined list of preventive medications bypasses the deductible and includes treatments for chronic conditions such as:
These medications help support ongoing health management while reducing upfront costs.
Best for: managing prescriptions, refilling medications, tracking orders, and accessing your digital ID card.The Optum Rx mobile application enables users to efficiently manage their prescriptions and maintain adherence to their medication regimens. This is particularly beneficial for individuals with chronic conditions such as diabetes, hypertension, and high cholesterol. With the app, you can:
The Optum Rx app helps you stay on track with taking your long-term medicines as prescribed. Long-term medicines are those used to treat conditions such as diabetes, high blood pressure and high cholesterol. With the app you can:
Best for: saving on long-term medications and conveniently filling 90-day prescriptions at in-network retail pharmacies.
The Optum Rx Retail90 program allows you to fill up to a 90-day supply of maintenance medications at in-network retail pharmacies, helping you stay on track with treatment for ongoing conditions. With Retail90, you can:
Choose what works best for you, with the flexibility to use either Retail90 pharmacies or home delivery for long-term medications.
Best for: specialty medications; offers supportive care programs and access to manufacturer copay assistance, where available.
Specialty Copay Assistance Program
Optum Specialty Pharmacy helps coordinate access to manufacturer copay assistance programs for eligible specialty medications. If you are prescribed a specialty drug, you may be contacted by the Optum Specialty team to discuss financial assistance options. Dedicated support teams can help guide enrollment and answer questions about available programs.
Optum Specialty Pharmacy Services
Optum Specialty Pharmacy is a full-service specialty pharmacy that provides home delivery for specialty medications. The pharmacy offers condition-specific care teams that deliver personalized support, including medication education, adherence guidance, and ongoing monitoring for patients with complex conditions. For more information or to get started with your specialty medication, visit specialty.optumrx.com orcall 877-838-2907.
Best for: medication comparison and finding savings through lower cost alternatives—ideal for those working with their doctor to develop a treatment plan.
In addition to your Optum Rx Pharmacy Plan, OneMain is pleased to offer access to the Scripta Insights application. Scripta finds prescription medications that are the same or clinically equivalent to the ones you’re already taking, but at a lower cost to you. If you have an opportunity to save, you’ll receive a Personalized Savings Report that lists your current prescriptions and lower-priced options to discuss with your doctor.
Please note: prescriptions filled using your ESI benefit will apply to deductible and out-of-pocket expenses. If you opt to fill a prescription using the coupon or cash price feature, your expenses will not count towards your deductible or out-of-pocket expenses.
This benefit is only covered under the UHC medical plans and the Surest Copay Plan.
Your pharmacy benefit plan includes access to a Free Meter Program, giving you the opportunity to receive a blood glucose meter at no cost. Regular blood glucose testing can help you better manage your diabetes and support improved glucose control.
How it works:
Getting started is simple.
Ordering your meter
You can order a CONTOUR® brand meter by:
The Benefits Service Center is made available to you through the HRConnect Self-Service Portal, providing support from dedicated professionals committed to helping you understand the benefit options available to you. Whether you have questions about your benefit plans, concerns about coverage, or just need guidance on which medical plan is right for you and your family, connect with the Benefits Service Center.
Contact HRConnect
This Digital Benefits Guide is intended to highlight available benefits and should not be relied upon to fully determine coverage. They are not complete descriptions of the benefits. The company may terminate or modify any benefits described on this website, at any time, for any reason. The descriptions listed on this website are not guarantees of coverage. If there is any conflict between this website and the official plan documents, the official plan documents and contracts will prevail.
Summary of Benefits Coverage are available within this Digital Benefits Guide as well as on MainStreet under Total REWARDS and Workday under My Benefits.
