Page 9 - 2020 DAN Benefits Enrollment
P. 9
Pharmacy Plan Highlights
When you enroll in a UnitedHealthcare medical plan, you and your covered dependents automatically
receive prescription drug beneits through OptumRx. For information on the quantity limitation and/or
pre-authorization requirements for certain prescription drugs, visit www.myuhc.com. The prescription
plan follows the Advantage Prescription Drug List (PDL), which is updated twice a year on January 1
and July 1. If your prescription drug medication changes as a result of the Advantage PDL, OptumRx
will notify you directly. You can always view the current PDL at www.myuhc.com.
Your prescription drug co-pay and deductible will vary depending on the plan you choose. The table
below outlines the different costs.
High Deductible
Enhanced Plan Standard Plan
Health Plan (HDHP)
Mail Order/ Mail Order/ Mail Order/
Plan Feature Retail Retail Retail
Retail 90 Retail 90 Retail 90
Tier 1 $10 copay $20 co-pay $10 copay $20 co-pay
Ded. and Coin.
Tier 2 $50 copay $100 co-pay $50 copay $100 co-pay Ded. and Coin.
Ded. and Coin.
Tier 3 $75 copay $150 co-pay $75 copay $150 co-pay
Retail 90 for Maintenance Medications
To better it your needs, our medical plans allow you to ill your maintenance medications
through a Walgreens or Duane Reade pharmacy in a 90-day supply for only 2x their retail
copay. This saves you time and money with reduced copays and reduced trips to the pharmacy!
This retail program is 100% optional. This program only applies at Walgreens and Duane Reade
pharmacies. 90 day mail order prescriptions are still available through OptumRX.
The HDHP Plan covers select preventive medications at no cost to plan participants. Review the
list of covered medications at www.myuhc.com or the UHC pre-member website
Dentsu Aegis Network 9
When you enroll in a UnitedHealthcare medical plan, you and your covered dependents automatically
receive prescription drug beneits through OptumRx. For information on the quantity limitation and/or
pre-authorization requirements for certain prescription drugs, visit www.myuhc.com. The prescription
plan follows the Advantage Prescription Drug List (PDL), which is updated twice a year on January 1
and July 1. If your prescription drug medication changes as a result of the Advantage PDL, OptumRx
will notify you directly. You can always view the current PDL at www.myuhc.com.
Your prescription drug co-pay and deductible will vary depending on the plan you choose. The table
below outlines the different costs.
High Deductible
Enhanced Plan Standard Plan
Health Plan (HDHP)
Mail Order/ Mail Order/ Mail Order/
Plan Feature Retail Retail Retail
Retail 90 Retail 90 Retail 90
Tier 1 $10 copay $20 co-pay $10 copay $20 co-pay
Ded. and Coin.
Tier 2 $50 copay $100 co-pay $50 copay $100 co-pay Ded. and Coin.
Ded. and Coin.
Tier 3 $75 copay $150 co-pay $75 copay $150 co-pay
Retail 90 for Maintenance Medications
To better it your needs, our medical plans allow you to ill your maintenance medications
through a Walgreens or Duane Reade pharmacy in a 90-day supply for only 2x their retail
copay. This saves you time and money with reduced copays and reduced trips to the pharmacy!
This retail program is 100% optional. This program only applies at Walgreens and Duane Reade
pharmacies. 90 day mail order prescriptions are still available through OptumRX.
The HDHP Plan covers select preventive medications at no cost to plan participants. Review the
list of covered medications at www.myuhc.com or the UHC pre-member website
Dentsu Aegis Network 9
