Pharmacy Benefit FAQ

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 prescriptions under your pharmacy benefit.

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 January 1st.

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

  • 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 remaining refills.
  • 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 at (877) 633-4461. Note: The OptumRx Home 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 to OptumRx. You must update that information by registering for your OptumRx online account or by calling OptumRx Customer Services toll-free at (877) 633-4461.
  • Remember to present your new member ID card to the pharmacy when accessing your prescriptions.

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 (877) 633-4461.

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

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.

Does OptumRx offer a Mail Order option?

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 from year to year. 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.

  • 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 again.
  • 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 need  to talk to your provider and switch to the lower copay drug before you will experience an increase in copay amounts.
  • If you have further questions, 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?

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.

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, you will need to talk to your provider about alternative medications that are potentially less expensive before you are charged the higher amount.

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 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 need 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. For more information about the OptumRx formulary, you may call OptumRx Customer Service toll-free at (877) 633-4461 or ask your provider to contact OptumRx toll-free at 1 (800) 626-0072 to start the prior authorization process.

What is the OptumRx Customer Service phone number?

(877) 633-4461

What is the OptumRx PA Department phone number?

1 (800) 626-0072

Which Customer Service number should be called?

Contact the OptumRx Customer Service number at (877) 633-4461

Where can I find the formulary?

For 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. 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?

To be covered under your health plan, your specialty medications must be filled at Memorial Hermann Specialty Pharmacy. Learn more by visiting https://specialtypharmacy.memorialhermann.org and by reading their Frequently Asked Questions.

Back to top ^