SHP Prescription Plan

The prescription plan coverage period runs concurrent with the medical plan, and is subject to the same plan termination provisions outlined in the SHP Summary Guide.

Prescription Plan Annual An out-of-pocket expense you would need to pay during a 1 year coverage period before your plan begins to pay at an in-network or out-of-network rate.

The prescription plan has an annual deductible of $100/individual or $200/family.
Your deductible is an out-of-pocket expense you would need to pay before the plan starts paying their share of the cost.
Your plan deductible is annual and is reset at the start of each 12-month coverage period. Once you meet your deductible for the plan year, you do not need to pay towards the deductible for the remainder of that year.
When the next 12-month coverage period begins (for the Student Health Plan it is August 1st each year), a new $100 deductible (or $200/family) will be applied to the new plan year. Meaning, every year you will be subject to a new deductible.

Preventive Medications

Medications that are classified as preventive may be eligible to you at $0 cost and $0 co-pay. View the list of preventive medications to see if your prescribed medication is eligible.

Prescription Tiers

Coverage for prescription medication is outlined in the Prescription Formulary, and is categorized into four tiers. These tiers determine which medications are covered by the plan and what the cost will be to you.

Tier 1: Generic

Tier 2: A prescription drug that does not have a generic equivalent.

Tier 3: A prescription drug that has a generic equivalent but you are opting to use the non-generic brand.

Tier E: Excluded- the medication not covered by the plan

If you have a documented medical reason or condition, which requires you to take a non-preferred brand or excluded medication, your prescribing provider may request a prior authorization through Optum Rx. If the prior authorization is approved, the medication would be assessed as a Tier 2 preferred brand with the lower Tier 2 co-pay.

Prescription Cost by Tier

Pharmacy/Retail: 30-day supply

$5 Generic (Tier 1)
$20 A prescription drug that does not have a generic equivalent. (Tier 2)
$70 A prescription drug that has a generic equivalent but you are opting to use the non-generic brand. (Tier 3)

Mail-Order: 90-day supply

To have your prescriptions delivered via mail, complete the OptumRx Mail Order form.

$10 Generic (Tier 1)
$40 Preferred Brand (Tier 2)
$140 Non-Preferred Brand (Tier 3)

Optum Rx Specialty Pharmacy: 30-day supply

Some specialty medications may only be covered through the Optum Rx Specialty Pharmacy.

$5 Generic (Tier 1)
$20 Preferred Brand (Tier 2)
$70 Non-Preferred Brand (Tier 3)

Early Refill of Medication

If you will be away from campus for an extended period of time, and need to refill a prescription before the plan will allow, you may request a prescription override through your prescribing provider to authorize early refill.

Requests for early refill must be made by the prescribing provider.
Requests made by the student for early refill will not be granted.
For University Health Services providers: an internal override form can be completed and emailed to the Student Health Plan Office at [email protected].
For off-campus providers: a request can be submitted through the OptumRx Pharmacy Portal, OptumRx Provider Relations at [email protected], or by calling Provider Services at 1-800-708-4414.

Questions about your prescription plan?

Contact Optum Rx Member Services via 1-877-615-6319 or their website.