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Pharmacy Prescriptions



Check the label: Find out if
Pharmacy Benefits the prescription drugs you are

Your prescription drug beneits are provided through OptumRx, a UHC taking now are on the UHC
list of preferred drugs (called
company. For further details please refer to the UHC or Medica website a formulary). To avoid any
at www.myuhc.com or www.mymedica.com. surprises, go to the UHC or
Medica website to review the
There are thousands of participating pharmacies throughout the country formulary. If your drug is not on
to meet your retail prescription needs. You also have the option of using the list you may want to ask your
mail order services for maintenance medication. Once the deductible doctor about a less expensive
alternative.
has been met, you will pay a copayment for prescription drugs according
to the schedule below. Your copayment amount is based on the type of
prescription being illed (generic, brand-name formulary, or brand-name
non-formulary), and whether you are obtaining your prescription from
a retail pharmacy or through the mail order option. You will pay only a
copayment for preventive prescriptions, regardless of whether or not the

deductible has been met (copayments for preventive prescriptions are not
applied to deductible).


Rx Formulary
Go to www.myuhc.com or www.mymedica.com for a complete and

up-to-date prescription drug listing (PDL) information. This website is
the best source for up-to-date information about the medications your
pharmacy beneit covers, possible lower-cost options, and how the cost
of medications compare. Be sure to check this listing before your
coverage begins with UHC.


Prescription Drug Plan* Retail Mail Order
(30-day) (90-day)
Tier 1 $10 $20
Tier 2 $30 $60
Tier 3 $50 $100

* Copayments apply to preventive prescriptions immediately, copayments apply to all other
prescriptions once the deductible has been met










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