Pharmacy benefits are managed by Optum Rx on behalf of the UC Student Health Insurance Plan (UC SHIP). There is no annual pharmacy benefit limit. Enrollees may purchase prescribed medications from any pharmacy, but will receive the greatest benefit from an in-network pharmacy.
| Billing | Optum Rx PO Box 968022 Schaumburg, IL 60196-8022 1-844-265-1879 |
| Member ID | Call: 1-866-940-8306 |
|
Rx Group # BIN Number |
UCSHIP 610011 |
| Network |
Optum Rx |
Benefit Summary
| IN-NETWORK | OUT-OF-NETWORK | |
| Generic | $5 co-pay | $5, then 60% of billed charges |
| Brand | $25 co-pay | $25, then 60% of billed charges |
| Non-formulary Brand | $40 co-pay | $40, then 60% of billed charges |
| Mail Order (90 day supply) | $15 generic $75 brand $120 non-formulary brand |
Not determined at this time. |
| Prescription Benefit Year Maximum | unlimited | unlimited |
Students can get partial reimbursement for medication obtained outside of network pharmacies. Students must mail a Prescription Claim Form to the claims administrator within 90 days of the date of purchase. If it is not reasonably possible to submit within that time frame, an extension of up to 12 months will be allowed. Prescription claim forms and customer service are available by calling 1 (844) 265-1879.
To receive your prescriptions via Mail Order with free standard shipping, please complete the OptumRx Home Delivery Form and mail or fax with your maintenance prescription written for a 90-day supply. You also have the option to log onto the Optum Rx website to complete the form online. Once complete you can mail in the paper version of your prescription(s) or fill out a request for Optum Rx to fax your provider.
Information on the member's other medications (prescription and over the counter), allergies, health conditions, and method of payment are required prior to filling a script.
OptumRx Home Delivery
PO Box 2975
Mission, KS 66201
Tel: 1-888-637-5121
Fax: 1-888-637-5191
When out-of-California, students can locate a participating pharmacy by calling 1-844-265-1879. If students cannot locate a participating pharmacy, they can pay for the drug and submit a Prescription Claim Form to the claims administrators.
Download the Approved Formulary Drug List.
Download the Formulary Exclusion List.