Under most TBT Plans, OptumRx (formerly called Prescription Solutions) administers your TBT prescription drug benefits. For details about your Plan’s prescription drug coverage, see the Summary of Coverage for your TBT plan.
If your TBT Plan provides prescription drug coverage through OptumRx, you must use the OptumRx network of participating pharmacies to receive your medication. Contact OptumRx at (800) 797-9791 or 1-877-246-2976 to confirm that your pharmacy is in the network. Or visit the OptumRx web site (www.optumrx.com).
See Drug Benefits for HMO Participants (below) if your have coverage through an HMO option offered by TBT.
Prescription Drug ID Card though OptumRx
When the TBT Plan Administration Office receives your TBT Enrollment Form, OptumRx sends you a welcome package that includes program instructions, prescription drug ID cards, a list of participating retail chain pharmacies and a mail service brochure. Your prescription drug ID card lists only your name, but may be used by your covered dependents. If your spouse is covered under the Plan, you are sent two prescription drug ID cards. If you need additional prescription drug ID cards, contact the TBT Plan Administration Office. For newly eligible participants, a paper prescription drug ID card may be used until you receive your plastic cards from OptumRx. A temporary ID card is provided in your new participant enrollment packet or by contacting the TBT Plan Administration Office.
Use Generic Drugs
If your prescription drug coverage is through OptumRx, the Plan encourages you to ask your doctor to prescribe generic drugs instead of brand name drugs (when a generic equivalent is available). If for any reason you or your doctor request a brand name drug when a generic equivalent is available, the Plan pays for the brand name drug, but only up to the cost of the generic equivalent (after any applicable copayments are collected). Read about answers to commonly asked questions regarding generic drugs (PDF).
Mail Service Program
Under the OptumRx mail service program, the medicine is mailed directly to your home. The same restrictions and exclusions that apply to the prescription drug program also apply to the mail service program. To use this program, download, complete and mail in the OptumRx New Prescription Mail-In Order Form (PDF). For more information, contact the program directly at (800) 562-6223 or (877) 246-2976.
If You Need Injectable Medications
Most injectable medications are ONLY covered when filled through the OptumRx mail order Specialty Pharmacy Program and are restricted to a 30-day supply. If you have questions about the Specialty Pharmacy Program or covered injectable medicines, contact the OptumRx help desk at (800) 562-6223. If you have other questions, contact the TBT Plan Administration Office and ask for the Pharmacy Unit.
Drug Benefits for HMO Participants
For most TBT Plans, prescription drug coverage is provided by TBT through OptumRx even if you choose an HMO. However, some TBT Plans (such as Plans I-A, III-A, V-A and VI) require that participants who enroll in the Kaiser HMO use only Kaiser facility pharmacies or mail service. In these cases, your prescription drug benefits are provided by the HMO rather than through the TBT prescription drug coverage explained above.
The Kaiser HMO also requires that participants in Plans I-A, III-A, V-A and VI use their drug formulary’s list of medications that are approved by their Kaiser pharmacy in your service area.
For details, contact Kaiser member services at (800) 464-4000. See the Comparison of Medical Benefits for your TBT plan and your Plan’s separate Kaiser materials including the Evidence of Coverage and Disclosure form.