Pharmacy Benefit Information
Below you will find helpful information pertaining to the prescription drug benefits.
To find if your drug is covered, please refer to our Drug Lookup Tool. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).
To view your specific RX benefit information, login to: http://optumrx.com/catamaranrx. (Please note that by clicking on this link, you will be leaving the Memorial Hermann website).
Download our Comprehensive Drug Formulary.
* Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of OptumRx. The presence of a medication on this formulary list does not guarantee coverage. To determine the most up-to-date formulary status of your medication, please visit your OptumRX member portal website or call member services at the number listed on your ID card.
To learn more about our Drug Formulary, click here.
Specialty Drug List
The BriovaRx Specialty Drug List is a listing by therapy of specialty medications that BriovaRx Specialty Pharmacy can provide or facilitate access and is subject to change. For more information about Specialty drugs, please visit BriovaRx.
Utilization Management (UM) Requirements
For certain prescription drugs, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed these requirements to help our members use drugs in the most effective ways. These special rules also help control overall drug costs, which keeps your drug coverage more affordable.
In general, our rules encourage you to get a drug that is safe and works for your medical condition. Whenever a safe, lower-cost drug will work medically just as well as a higher-cost drug, the plan’s rules are designed to encourage you and your doctor to use that lower-cost option.
Note: The Utilization Management (UM) Requirements will be available soon. Please refer to our 2017 Comprehensive Formulary to determine specific drug coverage information.
Rx Preventive Services
In addition to a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. Preventive medications are defined as those prescribed to prevent the occurrence of a chronic disease or condition for those individuals with risk factors, or to prevent the recurrence of a disease or condition. Some examples of the medications listed are for high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, and heart disease. This list provides examples of your preventive medications by drug category/therapeutic classification. Medications may be added to or removed from the list, depending on different factors, including the intended purpose of the medication and new medications.
If you experience a disruption to one of your current medications during the first 60 days of enrollment, we can provide a temporary one month supply while you consult with your physician. If it is decided that a formulary alternative is not best for your situation and should remain on the drug, you can then ask the plan for a formulary exception.
To located a pharmacy near you, use our Pharmacy Locator Tool. (Please note that by clicking on this link, you will be leaving Memorial Hermann Advantage website).
The OptumRx® pharmacy network includes many national chain pharmacies listed in this OptumRx Pharmacy Network Listing document. Many independent pharmacies are also included in the network. Visit http://optumrx.com/catamaranrx for a comprehensive listing of network pharmacies or call member services with the phone number located on your pharmacy ID card. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).
Home Delivery Information and Forms
Are you taking a "long-term" medication? Enroll in home delivery. Save money and time. Learn more by reading these Home Delivery Frequently Asked Questions and download New Prescription Mail Order Forms in English and Spanish.
Introducing BriovaRx™ Specialty Pharmacy
Enjoy personalized patient care, complete consultation, regular follow-up and fast reliable service with BriovaRx™ Specialty Pharmacy. Learn more by visiting BriovaRx.com and by reading their Frequently Asked Questions. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).
OptumRx Member Portal
This private, secure website is designed just for you. All of your pharmacy plan information is available and kept up-to-date in real time.
Easy access allows you to:
- Manage all your prescriptions on a single dashboard
- Update your information and complete health profile
for home delivery
- Order mail order refills
- Compare prices at local pharmacies
- Find your lowest prescription cost
- Locate your pharmacy and get driving directions
- Keep track of your health history
- Learn more about your drugs
- Take it all with you through the mobile app
- Manage prescriptions for your dependents and family members, where appropriate
- And much more.
Visit http://optumrx.com/catamaranrx and use your member ID number to register. Questions? Call OptumRX Customer Service at 1-877-633-4461. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).
OptumRx Mobile App
The mobile app provides easy, on-the-go access to your personalized health information. Once you have your member ID number, download the app to take advantage of the benefits your pharmacy plan offers.
Managing your prescription medications is a key part of managing your health. Take your medication information with you wherever you are with the mobile app. Download now for iOS and Android devices. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).
For more information on your pharmacy benefits, contact OptumRX Customer Service at 1-877-633-4461.
Additional Documents and Forms
Member Reimbursement Drug Claim Form - English
Member Reimbursement Drug Claim Form - Spanish
For Prior Authorizations, download a Texas Prior Authorization Form. For more information, contact the OptumRx Prior Authorization Department by phone at 1-800-626-0072
or by fax at 1-866-511-2202.
If you disagree with a Prior Authorization decision, you have the option to appeal the decision within 180 calendar days. For Appeals, download the OptumRx Appeal Request Form. For more information, contact the OptumRx Appeal Department by phone at 1-800-626-0072 or by fax at 1-866-511-2202.