Southeast Missouri State University

Prescription drug benefits will be available through UnitedHealthcare Pharmacy Benefit Program. To receive retail prescription drug benefits under the health plan, covered employees must present their UnitedHealthcare ID card to the dispensing pharmacist at the time of filling the prescription. If you purchase a prescription drug from a non-network pharmacy, you are responsible for any difference between what the non-network pharmacy charges and the amount contracted for the same prescription drug dispensed by a network pharmacy.

Prescription Services for the Base Plan

Under the Base Plan, you are allowed up to a 31-day supply of prescription drugs. You will pay the full amount UnitedHealthcare has contracted with the pharmacy to charge for your prescriptions (not just your copayment), until you have satisfied the deductible. Once the deductible is satisfied, your prescriptions will be subject to the copayments outlined under the program's Copayment Tier Levels. If you reach the Out-of-Pocket maximum, you will not be required to pay a copayment.

Prescription Services for the Accelerated Plan

Under the Accelerated Plan, you are allowed up to a 31-day supply of prescription drugs. This program is not subjected to the plan's deductible or cost share. If you reach the Out-of-Pocket maximum, you will continue to pay the applicable copayments outlined under the program's Copayment Tier Levels.

Mail Order Prescription Services

UnitedHealthcare also offers a mail service through Optum Rx. This program is available with the Base Plan and the Accelerated Plan. You could save money by ordering up to a 90-day supply of medication for just one mail order copayment. Your medications are mailed to you with free standard shipping.

Copayment Tier Levels

Tier Level Retail
Up to 31-day supply
Retail
Up to 31-day supply
Mail Order
Up to 90-day supply
  Network Non-Network Network
Tier 1 $10 $10 $25
Tier 2 $35 $35 $87.50
Tier 3 $60 $60 $150

 

Half Tablet Handout
Download: (Adobe PDF)
An overview of the Half Tablet program

OPTUMRx Order Form
Download: (Adobe PDF)
Form used to order your prescription drug using the mail-order service

Pharmacy Benefit Program
Download: (Adobe PDF)
A guide to UnitedHealthcare pharmacy benefits

Prescription for Over-the-Counter Medication
Download: (Adobe PDF)
Form used to accompany all requests for reimbursement for over-the-counter drugs and medicines

Refill and Save
Download: (Adobe PDF)
A guide to refilling your prescription drugs

Specialty Injectable Medications List
Download: (Adobe PDF)
UHC tier list for specialty injectable medications

The Select Designated Pharmacy Program
Download: (Adobe PDF)
A reference guide to understanding the Select Designated Pharmacy program

UnitedHealthcare Three-Tier Prescription Drug List
Download: (Adobe PDF)
A reference guide to understanding your pharmacy prescription drug list

UnitedHealthcare Half Tablet Program
Download: (Adobe PDF)
A guide to using the Half Tablet program

The University reserves the right to modify or terminate such plans at any time with or without notice. Participation in these plans is provided to eligible employees and does not constitute a guarantee of employment. Participation is subject to the terms and conditions specified in the plan documents.

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