2018 Officers - Prescription Drug Coverage

When you enroll in any Columbia medical plan, you are automatically enrolled in Columbia University’s Prescription Drug Plan. OptumRx administers the Prescription Drug benefits plan for the University.
 

Using Your Prescription Drug Benefit

After you enroll in medical benefits, you will receive a Medical ID card which will include your medical and prescription drug plan information.
 
Retail*
You will need to present your ID card at the pharmacy the first time you fill a prescription. You can have up to a 30-day supply of your prescription when filled at a retail pharmacy.
  • In New York, New Jersey and certain other states, the pharmacy is required by law to substitute a brand name drug with a generic. Your copay will be $10. If the cost of the generic drug is less than $10, you will only pay the cost of  the drug. 
     
  • If your physician prescribes the brand-name drug instead of the generic, then you will pay the highest copay, $45. Your physician must request the pharmacist “Dispense as Written” to receive the brand-name drug.
     
  • If no generic is available for your prescription, then your drug is a single-source prescription. Your copay will be $25.  
Mail-Order
Mail-order copays are for up to a 90-day supply. If you take medication on a regular basis for conditions such as high blood pressure or asthma, the mail-order option will be less expensive than the retail option.
 
After you have enrolled in the OptumRx mail-order program, you can refill prescriptions easily, either online or over the phone.
  
Specialty Medications
Specialty medications must be purchased via mail-order from BriovaRx, an OptumRx specialty pharmacy. BriovaRx will mail your prescription to you at the address of your choice. For your privacy, the package is delivered in a non-labeled box. Call 855-427-4682 to speak to a patient care representative. Typically, you will receive a 30-day supply of the prescription at the retail pharmacy copay.
Note: If you use a pharmacy other than BriovaRx, you will be subject to the full cost of the medication instead of copays.
 
Prescription Drug Costs
The cost of your prescriptions depends on a number of factors, including the medical plan in which you are enrolled, whether you buy your medication through a retail pharmacy or through the mail-order program and whether the drug is a single-source or multi-source drug.
 
* Copays are different in the HDHP if the prescription is a non-preventive drug. 
 
PRESCRIPTION DRUG SERVICES
To find participating pharmacies or enroll in the OptumRx mail-order program, log in to www.myuhc.com and click “Manage Your Prescriptions” then “Go to OptumRx.” You may also call 800-232-9357 for assistance. 
 

Copays

Copays for prescription drugs work differently under the Choice Plus plans and the High Deductible Health Plan (HDHP). However, under all of the plans, the copays and deductible accumulate toward the out-of-pocket maximum for your plan. Therefore, once you reach the annual out-of-pocket maximum, the Plan pays 100% of the cost of prescription drugs (preventive and non-preventive).
  • Under the Choice Plus plans, all prescription drugs are subject to a copay. 
     
  • Under the High Deductible Health Plan (HDHP), preventive drugs and nonpreventive drugs are treated differently.
    • Preventive Drugs: Prescription drugs that are categorized as “preventive” under federal guidelines are not subject to the HDHP deductible, so you are only responsible for paying the copay. Copays accumulate toward your out-of-pocket maximum. Preventive drugs under federal guidelines include medications such as anticoagulants, cholesterol lowering agents and prenatal vitamins. To check if your prescription is considered preventive, please call OptumRx at 800-232-9357. 
       
    • Non-Preventive Prescription Drugs: Prescription drugs that are categorized as “non-preventive” under federal guidelines are subject to the HDHP deductible. This means you will pay the entire cost for your non-preventive prescription drugs until you meet the plan deductible. Once the deductible is met, the prescription drug copay will apply. Note: you will receive a discount on the cost of your prescription drugs if you use an OptumRx participating pharmacy.  
 
Copay Options
Plan Retail Pharmacy  
 
Pharmacy (up to 30-day supply)Mail-order (up to 90-day supply)
Choice Plus (80, 90, 100)• $10 generic
• $25 single-source
• $45 multi-source
• $15 generic
• $50 single-source
• $90 multi-source
High Deductible Health Plan (HDHP)
Preventive Drugs: 
• $10 generic
• $25 single-source
• $45 multi-source
 
Non-Preventive Drugs:
• Subject to HDHP in-network deductible; then Rx copays apply
Preventive Drugs:
• $15 generic
• $50 single-source
• $90 multi-source

Non-Preventive Drugs:
• Subject to HDHP in-network deductible; then Rx copays apply

 

IS A DRUG A "SINGLE-SOURCE" OR "MULTI-SOURCE"? 

   • If no generic is available, this is a single-source drug.  

   • If both a generic and brand name prescription are available, this is a multi-source drug.

To find out if a drug is single-source or multi-source, ask your pharmacist or contact OptumRx at 800-232-9357 or www.myuhc.com. 

Keep in mind that your prescription may move from “single-source” to “multi-source” during the year due to periodic reviews or if the U.S. Food and Drug Administration (FDA) approves a generic equivalent drug.