Skip to Content

Resize text:

A A A
Call today for a free quote at (877) 364-2789

Pharmacy Benefit FAQ

How will OptumRx know what my plan benefits are?

Your health plan will provide the plan benefit information to OptumRx automatically. You will also be issued a new member ID card. Provide this card to your pharmacy to process new pharmacy prescriptions under your pharmacy benefit.

Will I need a new member ID card?

Yes. A member ID card will be sent by the member's health plan in December. If you need to order a permanent replacement card, please contact our Customer Service at 713-338-4683.

Helpful Advice – Remember to present the new member ID card to your pharmacy so that they can access your benefits. If you do not have the new member ID card handy, you may use the primary cardholder’s social security number to process the pharmacy claim until you have received your new member ID card, after 1/1/2016.

What type of pharmacy benefits information will automatically transfer to OptumRx?

  • Retail Pharmacy: Your benefit information will transfer automatically. The only action required is to present your new member ID card to your pharmacy.
  • Prior Authorizations: Any prior authorizations your provider has secured for your current prescriptions will be transferred to OptumRx. This means that current approvals for prior authorizations will rollover into the OptumRx system and will keep the original start and end dates.

What type of pharmacy benefits information will NOT transfer to OptumRx?

In summary:

  • You will need a new prescription from your provider for any controlled substances, narcotics, compound medications, or if your prescription has either expired or does not have any refills remaining at CVS mail order.
  • Mail Order prescriptions and the auto-refill feature are not automatically transferred to OptumRx. Instead, you will need to set up the mail delivery option by contacting OptumRx Home Delivery Customer Services toll-free by calling 1-877-633-4461.
    Note: OptumRx Mail Order facility will reach out to you with information on how to continue that service. Be aware that there is not an auto-refill feature under OptumRx.
  • Payment information like credit card or debit card numbers will not transfer from CVS Health to OptumRx. You must update that information by registering for your OptumRx online account or calling the OptumRx Customer Services toll-free number at 877-633-4461 on or after January 1, 2016.
  • Remember to present your new member ID card to the pharmacy when accessing your prescriptions.

What will happen to my current retail prescriptions?

Starting January 1, 2016 just present your new Memorial Hermann member ID card to the pharmacist when filling a new prescription or a refill for you or a covered family member.

Helpful Advice - If you call in your prescription refill and the pharmacy runs your order with your old insurance information, it will appear that your insurance has terminated. Just provide the pharmacy with your new Memorial Hermann member ID card and ask them to reprocess the prescription with your updated insurance information. If you do not have that information, call OptumRx Customer Service at 1-877-633-4461.

How do I find a participating retail pharmacy?

You can find a participating retail pharmacy near you by calling OptumRx Customer Services toll-free at 1-877-633-4461.

How do I refill my current mail order prescriptions through the OptumRx Mail Order Pharmacy?

On December 31, 2015, you will need a new prescription for mail order service. This means that the prescribing physician will need to be contacted in order to provide a brand new prescription. Members need to register at http://optumrx.com/catamaranrx before they can fill or request refills for mail order prescriptions. Information from the new member ID card is needed to register and members can register by phone, mail or online. Home delivery forms and FAQs are available online at http://optumrx.com/catamaranrx.

The OptumRx Mail Order facility will reach out to you with information on how to continue that service.

Note: You should expect to receive your mail order prescriptions 14 days after OptumRx receives your refill request. Make sure you have an adequate supply of your medication on hand to allow for this period.

What happens if I need to refill my current mail order prescriptions prior to January 1, 2016?

If you need a refill before January 1, 2016, please order your prescription through the current mail order pharmacy.

Does OptumRx offer a Mail Order option similar to CVS Health?

Yes, please contact 877-633-4461 or visit the website http://optumrx.com/catamaranrx for more information on how to sign up for home delivery. After you enroll a prescription in home delivery, OptumRx will send your prescription or prescription refill after verifying your credit/debit card information.

Will there be changes to the cost of my medications?

It is possible that the cost of particular medications will change due to differences between the drug formulary at CVS Health and OptumRx. Currently, your prescription drug benefit has four levels of copayment for both retail prescriptions and mail order prescriptions. The four levels are called generic, preferred, non-preferred, and Specialty. The copayment amount at each level is not changing with OptumRx. However, the drug may be classified as a different level with OptumRx.

  • Some medications may experience a decrease in copayment amount. For example, a drug may move from a non-preferred drug to a preferred drug status. If this applies to a medication that you are currently taking, you will experience cost savings when you fill your prescription on or after January 1, 2016.
  • Some medications may experience an increase in copayment amount. For example, a drug may move from a preferred drug to a non-preferred drug status. If this applies to a medication that you are currently taking, you will receive a formulary change letter from OptumRx in mid-December. Your non-preferred medication will be listed along with a preferred or generic alternative. You will have until January 1, 2016 to talk to your provider and switch to the lower copay drug before you will experience the increase in copay amounts. The cost of the non-preferred medication will increase to the non-preferred copay amount for any refills on or after January 1, 2016.
  • If you have further questions about your pharmacy benefit transition, please contact Customer Service at 713-338-4683. After January 1st, please contact OptumRx customer service for more information about your drug benefits.

How will I know which copay amount I will pay for my medication?

On December 25th, you may look up the medication at www.healthplan.memorialhermann.org or contact the toll-free Customer Service phone number located on the back of your member ID card to find out the copay amount for your medications.

In January, you may sign up for a private member portal at OptumRx website at http://optumrx.com/catamaranrx for more personalized information about your drug coverage.

If the copay amount provided is on a higher tier (example: Moved from Brand Formulary to Brand Non-Formulary) from what you are accustomed to paying in 2015, you will have until January 1, 2016 to talk to your provider about alternative medications that are potentially less expensive before you are charged the higher amount. You will be responsible for the full copay amount based on the OptumRx formulary for refills requested on or after January 1, 2016.

Is it possible that OptumRx will not cover a medication that I am currently taking?

  • It is possible that a prescription drug that you are currently taking will not be covered under the new formulary at OptumRx. If this applies to you, a formulary change letter from OptumRx will be sent home in mid-December explaining that the medication is on the “Excluded Medications” list and will also provide an alternative medication. You will have until January 1, 2016 to talk to your provider and switch to an alternative drug before you will experience the full cost of the medication.
  • If your provider wishes for you to continue receiving the excluded medication, the prior authorization process will need to be followed to gain coverage from OptumRx. As a reminder, medications that have current approvals for prior authorizations will roll over in 2016. For more information about the OptumRx formulary, you may call OptumRx Customer Service at 877-633-4461 or ask your provider to contact OptumRx at 1-800-626-0072 to start the prior authorization process.

Are my benefits changing?

No, your plan's prescription drug benefits, such as prescription deductibles and copayments, are not changing due to the new Pharmacy Benefit Manager transition to OptumRx. If there is a change in coverage to a drug that you are currently taking, you will receive a notification in the mail. If your drug is not on the OptumRx Formulary, please discuss with your physician for an appropriate formulary alternative.

What is the OptumRx Customer Service phone number?

1-877-633-4461

What is the OptumRx PA Department phone number?

1-800-626-0072

Which Customer Service number should be called?

Before 1/1/2016, contact the Memorial Hermann Customer Service number at 713-338-4683.

On or after 1/1/2016, contact the OptumRx Customer Service number at 1-877-633-4461.

Where can I find the formulary?

The formulary will be posted onto our new website by December 25 at http://healthplan.memorialhermann.org/members/. Members can get more information from their personalized online member portal by creating an account at http://optumrx.com/catamaranrx.

Where do I fill my Specialty medications?

BriovaRx is the preferred Specialty pharmacy for OptumRx. To be covered under your health plan, your specialty medications must be filled at BriovaRx Specialty Pharmacy.