2021 OptumRx prescription drug changes

Wake Forest University Human Resources emailed the following message to faculty and staff who have elected to receive medical coverage through Wake Forest University for calendar year 2021; those enrolled in the medical plan for 2021 are automatically enrolled in the OptumRx prescription drug plan. 

As a reminder, we have included two important plan updates below that were communicated to you during the annual benefits enrollment period.

  1. Mail Order Program – enroll and save

Beginning January 2021, you will have the choice of utilizing the OptumRx Mail Order Program to receive your maintenance medications* or to use a retail pharmacy. The Mail Order Program allows you to receive a 90-day supply of maintenance medications at a lower copay. If you continue to receive maintenance medications at a retail pharmacy, you will pay an additional copay after two 30-day supply refills. This change does not impact non-maintenance medications.

*Maintenance medications are prescriptions that are commonly used to treat chronic or long-term conditions such as high blood pressure, asthma, heart disease, diabetes, etc.

There are three ways to enroll in the OptumRx Mail Order Program:

  1. ePrescribe: Ask your doctor to send an electronic prescription to OptumRx.
  2. Online: Visit optumrx.com and select Get Started or use the OptumRx app. From there, you can fill new prescriptions, transfer others to home delivery, and more.
  3. Phone: Call (844) 265-1875 to speak to a customer service advocate.

Once OptumRx receives your complete order for a new prescription, your medication should arrive within 10 business days. Completed refill orders should arrive in about seven business days.

  1. Formulary Change – verify prescription coverage and cost

Also beginning January 2021, the prescription drug plan will transition from the Select to the Premium Formulary with new Utilization Management programs that may include restrictions such as prior authorizations**, step therapy***, and quantity limits. All impacted members were sent a letter from OptumRx notifying them of these changes. Please review these letters and follow the instructions which could include asking your doctor to call OptumRx. Plan members utilizing behavioral health prescriptions will have a 12-month advance notice period beginning January 2021.

Prior Authorizations**: Some medications must be authorized by a doctor before you can receive them because they are only effective and/or approved for certain conditions. You, your pharmacist, or your doctor can start the prior authorization process by contacting OptumRx. OptumRx will work with your doctor to get the information needed for the review. Once a prior authorization form is submitted by your doctor, a review will be conducted within a few days and a determination letter will be sent to you and your doctor.

Step Therapy***: Some medications are more cost effective in the initial steps of treatment. The step therapy program provides an opportunity to save money by using clinically approved and cost-effective medications as a first step. This allows you to try a less expensive medication before a more costly one.

Visit the Prescription Drug Lookup portal to verify if a prescription drug will be covered and/or if it has any restrictions beginning January 1, 2021. Visit the Prescription Drug Pricing portal to verify the cost of a prescription drug (drug prices are subject to change based on individual retail pharmacies).

For questions regarding your prescriptions, please contact OptumRx at (844) 265-1875.

Visit hr.wfu.edu for more information about these prescription plan changes or contact Human Resources at askhr@nullwfu.edu or (336) 758-4700 with additional questions.

Wake Forest University Human Resources