Prescription Drugs

Quick Reference

Website
Call OptumRx customer service: 800-788-7871
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Coverage Highlights

  • OptumRx administers the Fund’s prescription drug plan
  • You must use an OptumRx network retail pharmacy or the OptumRx mail order program to receive prescription drug benefits
  • Prescription drugs purchased from non-network retail pharmacies or outside of the mail order program are not covered
Drug Tier Retail
(up to a 30-day supply)
Mail Order
(up to a 90-day supply)
Generic $10 copayment $20 copayment
Preferred Brand Name $30 copayment $60 copayment
Non-Preferred Brand Name $50 copayment $100 copayment
Annual Out-of-Pocket Maximum
(separate from the Medical Plan)
$1,000 individual
$2,000 family
$1,000 individual
$2,000 family

Details

Heat and Frost Insulators Local No. 33 Health Fund SPD