Your Physical Health

Your Pharmacy Program

OptumRx manages Cision’s prescription drug plan. This contact information will also be on the back of your medical ID card. The information outlined below will help you to make the most of your pharmacy benefits.

OptumRx Pharmacy Network

You have access to OptumRx home delivery and a large network of retail pharmacies, including large national chains and many local pharmacies. Finding a network pharmacy is easy with your online account or the OptumRx app. Additionally, Optum’s network of specialty pharmacies provides specialty medications and clinical support for complex conditions like cancer and MS. To learn more about specialty pharmacy call 1.855.524.0381.

CVS Saver Program

Members may get their 90-day supplies of maintenance medications at nearly 9,700 CVS pharmacies or through OptumRx home delivery — the choice is up to you. Our pharmacy benefit covers 2 grace fills of 34-day refills of a maintenance medication at a pharmacy of your choice. After the allowed refills, you must choose to fill your prescription from OptumRx home delivery or CVS pharmacy, or pay a higher cost share. You will only be able to get a 90 day supply through home delivery or CVS. Click here to learn more.

Medication Home Delivery

OptumRx home delivery is a convenient and cost-effective option for medications you take regularly. OptumRx home delivery lets you order up to a 3-month supply of medications you take regularly. You can submit your order online, through the app, by phone, or mail. OptumRx will fill your order and ship it directly to you, saving you trips to the pharmacy. You can also set-up reminders to help you remember when to take your medication and refill your prescriptions.

OptumRx Formulary (Premium Formulary)

To learn if your medication is covered, members should access pharmacy coverage via the member portal, app, or customer service. This will provide current and accurate information for the member’s specific plan. In addition to telling you if your medication is covered, a formulary also:

  • Identifies medications for certain conditions and organizes them into cost levels called tiers.
  • Lets you know if any medications require prior authorization or step therapy, which may affect how they are covered and how much they will cost.
  • Includes information about medications that may have quantity/supply limits or are considered a specialty medication.

Prior Authorization

Prior Authorization requires your doctor to tell OptumRx why you are taking a medication to determine if it will be covered under your pharmacy benefit. Some medications must be reviewed because they may only be approved or effective for safely treating specific conditions or cost more than other medications used to treat the same or similar conditions. You can find out if your medication requires prior authorization at the pharmacy, online or by calling OptumRx at 855.524.0381.

CVS Saver Program

Members may get their 90-day supplies of maintenance medications at nearly 9,700 CVS pharmacies or through OptumRx home delivery — the choice is up to you. Our pharmacy benefit covers 2 grace fills of 34-day refills of a maintenance medication at a pharmacy of your choice. After the allowed refills, you must choose to fill your prescription from OptumRx home delivery or CVS pharmacy, or pay a higher cost share. You will only be able to get a 90 day supply through home delivery or CVS.

Manufacturer Copay Card

If you use a drug manufacturer copay card to pay for your prescription(s), the amount covered by the copay card will NOT count toward your deductible or out-of-pocket limit. Only your true out-of-pocket costs will be applied to your deductible and out-of-pocket totals.

OptumRx Digital Tools

Questions?

If you need to better understand your plan or have questions on your medications, contact your Quantum Care Coordinators by calling 833.346.1479 or by going to mycisionbenefits.com.

Contact the Cision Benefits team

Prescription Drug Plan Summary

Our prescription drug plan is administered by OptumRx and you can receive different dispensing amounts based on place of service:

  • Retail pharmacy: up to 2 grace fills of 34-day refills of a maintenance medication then the CVS90 Saver program should be applied
  • Mail Order through OptumRx: Up to 90 day supply
  • CVS Retail pharmacy: Up to 90 day supply for maintenance drugs

PrescriptionsSaver HDHPValue HDHPChoice PPO
Prescriptions apply to medical deductibleYes, prescription drugs apply to combined medical/Rx deductibleYes, prescription drugs apply to combined medical/Rx deductibleNo
Prescriptions apply to medical out-of-pocket maximumYes, prescription drugs apply to combined medical/Rx out-of-pocket maximumsYes, prescription drugs apply to combined medical/Rx out-of-pocket maximumsYes, prescription drugs apply to combined medical/Rx out-of-pocket maximums
Retail Copay (34-day supply)
Generic0%10% ($0 min/$25 max)$10
Preferred0%25% ($25 min / $75 max)$35
Non-Preferred Brand0%35% ($35 min / $125 max)$55
Mail Order Copay (90 day supply) - Filled through OptumRx Home Delivery
Generic0%10% ($0 min/$50 max)$20
Preferred0%25% ($50 min / $150 max)$70
Non-Preferred Brand0%35% ($75 min / $250 max)$110
Specialty Drug Copay - Filled through Optum Specialty Pharmacy
Generic0%10% ($25 min/$25 max)$10
Preferred0%25% ($25 min / $75 max)$35
Non-Preferred Brand0%35% ($35 min / $125 max)$55
CVS 90 Saver Maintenance (Up to 90 day supply at CVS)
Generic0%10% ($0 min/$50 max)$20
Preferred0%25% ($50 min / $150 max)$70
Non-Preferred Brand0%35% ($75 min / $250 max)$110
Maintenance Drugs at Retail (not CVS90) - After 2 grace fills (34 day supply)
Generic0%15% ($0 min/$37.50 max)$15
Preferred0%37.5% ($37.50 min/$112.50 max)$52.50
Non-Preferred Brand0%52.5% ($52.50 min/$187.50 max)$82.50

Ready to enroll?

Visit UKG Pro to learn more and enroll in your benefits.
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