Prescription Plan

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.

    •   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 prescirption 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.