Prescription drug coverage provides a benefit that is important to your overall health, whether you need a prescription for a short-term health issue like bronchitis or an ongoing condition like high blood pressure. If you enroll in medical coverage, you will automatically receive coverage for prescription drugs. Express Scripts is the Pharmacy Benefits Manager.
Daw Pharmacy Benefit Update for Members
2022 Express Scripts High Performance Formulary List
Staring May 1st, 2023 – Optum Rx will be providing Pharmacy Benefit Services for Prime Healthcare HealthPlan Members
Visit optumrx.com to register your account. You’ll need information from your new member ID card to sign up. After May 1, 2023, access your account details and prescriptions using their online tools.
Get Smart About Prescriptions
Our online tools make it easy
After May 1, 2023, you can access:
See your current prescriptions along with information about how to use them and possible side effects.
Price a drug
Search your current or new medications to see costs at pharmacies near you. If you’re taking a brand-name drug, you can also see prices for generic options.
View my claims
See which prescriptions you’ve filled and how much you paid.
Search for network and on-site pharmacies near you — or find a pharmacy when you’re traveling.
Visit optumrx.com to register your account. You’ll need information from your new member ID card to sign up. Then, after May 1, 2023, access your account details and prescriptions.
Skip the pharmacy. We deliver to you.
If you take a medication regularly, you could save time and
money with Optum Home Delivery after May 1, 2023.
- Order up to a 3-month supply.
- Get your medications delivered right to your mailbox — with free standard shipping.
- Talk to a pharmacist 24/7
Submit your order one of three ways:
Online at optumrx.com
Via the Optum Rx app
Call the phone number on your member ID card
Will my current prescriptions transfer?
Yes, most will transfer to Optum Home Delivery. But prescriptions for some medications such as controlled substances will not transfer. In these cases, you’ll need a new prescription from your doctor.
What is a prior authorization?
Prior authorization (PA) requires your doctor to tell us 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
- Cost more than other medications used to treat the same or similar conditions
How can I find out if my medication requires PA?
At the pharmacy
When you fill a new prescription, your pharmacist will tell you if a PA is required.
Look online to see if your medication has a PA.
- Log into optumrx.com > Member tools
- Click on Drug pricing and information
- Enter the drug name and dose
- If the drug/dose you entered needs a prior authorization, you will see an alert below the drug name.
Coverage alert This drug requires a prior authorization from your provider. Please contact your provider to complete. If the prior authorization is approved, the actual price you pay may be different than the price listed.
On the phone
Call Optum Rx at the toll-free phone number on your member ID card.
What do I do if my medication needs a PA?
To begin the PA process, you can:
- Let your doctor know that a PA is needed for your medication.
- Call Optum Rx at the toll-free number on your member ID card.
How long does it take for a PA to be approved or denied?
Once your PA has been submitted and received, it usually takes up to 24 hours to process. If your PA request needs additional review, it may take longer. If your doctor submits a PA request electronically, they may receive approval within minutes of submitting the request.
How do I know if my medication has been approved for coverage?
Once we review the information from your doctor, we will send a letter to you and your doctor letting you know if your medication coverage is approved or denied.
- Check the status of your PA by signing into optumrx.com > Benefits and claims > Prior authorization or exception request. You will see the status of any active PAs in process.
- If your medication is approved, the PA is entered and coverage will be provided under your benefit. You can continue to fill your prescription at the pharmacy as usual during the approved PA period. Depending on your benefit plan and medication, you may be able to save money by using home delivery from Optum.
- If your medication is denied, we’ll send a letter telling you why and provide information about the appeal process.