Who is Optum Rx?

Optum Rx is the Prescription Benefits Manager for the State of Florida PPO and HMO Plans. For these plans, your pharmacy benefit is provided separately from your health insurance and you will receive an ID card from Optum Rx.

What medications are covered by the State of Florida plan?

For the most current list of covered medications, refer to the Preferred Drug List at <a href="https://www.mybenefits.myflorida.com/myhealth/prescription_drug_plan" class="underline text-blue-500 transition-colors ease-in-out duration-500 hover:text-blue-400">Mybenefits.myflorida.com/myhealth/prescription_drug_plan</a> or go to <a href="https://welcome.optumrx.com/sofdms/landing" class="underline text-blue-500 transition-colors ease-in-out duration-500 hover:text-blue-400">Welcome.OptumRx.com/sofdms</a> and choose the option &ldquo;Formulary Lookup&rdquo;.

How do I use the Preferred Drug List?

The Preferred Drug List is a valuable resource for you and your prescriber to select the most cost-effective prescription medications. This guide indicates whether a medication is generic or brand-name and notes any special rules that may apply.

How do I find the Optum Network Pharmacies?

You have a few options:&nbsp; &bull; Go to <a href="https://welcome.optumrx.com/sofdms/landing" class="underline text-blue-500 transition-colors ease-in-out duration-500 hover:text-blue-400">Welcome.OptumRx.com/sofdms</a> and choose the option "Find a network pharmacy" at the top of the screen.&nbsp; &bull; Access the Optum Rx app or log in to your account at <a href="https://www2.optumrx.com/" class="underline text-blue-500 transition-colors ease-in-out duration-500 hover:text-blue-400">OptumRx.com</a> to check the list of network pharmacies.&nbsp; &bull; Dial 800-547-9767 to connect with the Optum RX Call Center designated for the State of Florida.

Am I required to use Optum Home Delivery for my mail-order prescription?

No, you are not required to use Optum Home delivery for your mail-order prescription. You can choose from any home delivery or mail-order service, ensuring you get the best option that suits your needs. Experience the convenience of home delivery for your prescription medications. Skip the pharmacy lines and have up to a 90-day supply of your medications delivered right to your door.

What advantages come with filling a 90-day supply?

Not only can you save money by receiving 90-day quantities of your medicine for the same cost as two 30-day retail fills, but a longer supply also means fewer trips to the pharmacy. Experience cost savings by filling a 90-day supply, potentially eliminating the need for monthly pharmacy visits.

How do I take advantage of these cost savings when using a 90-day supply?

Visit a participating 90-day maintenance retail or mail order pharmacy to request a 90-day supply of the maintenance medications you take to treat chronic or long-term conditions (e.g., high blood pressure, high cholesterol, heart disease, asthma, diabetes). If you have a maintenance medication prescription for up to a 90-day supply, you may have it filled one of the three ways:&nbsp; &bull; Through Optum Home Delivery&nbsp; &bull; Mail order pharmacy&nbsp; &bull; Any retail pharmacy participating in a 90-day maintenance-at-retail network.&nbsp;The pharmacies in this network may or may not be in the regular 30-day retail network. Visit <a href="https://welcome.optumrx.com/sofdms/landing" class="underline text-blue-500 transition-colors ease-in-out duration-500 hover:text-blue-400">Welcome.OptumRx.com/sofdms</a> or call 800-547-9767 to find out if your retail pharmacy is choosing to participate in the 90-day maintenance-at-retail network.&nbsp;Copays for a prescription fill at a participating 90-day maintenance-at-retail pharmacy are the same as for mail order: $14 for generic drugs, $60 for preferred brand drugs, and $100 for non-preferred brand drugs.

Which medications am I required to fill through a 90-day retail pharmacy or mail order?

If you are enrolled in the PPO Plan, you must fill your maintenance medications through a participating 90-day retail pharmacy or a mail-order pharmacy after three fills at a 30-day retail pharmacy. Maintenance medications are typically used to treat chronic conditions that require regular or on-going use of medicines (e.g., hypertension, diabetes, high cholesterol, asthma).

How should my provider write my mail-order prescription?

Ask your healthcare provider to prescribe a supply of medication for up to 90 days with refills for a year, as appropriate. If the prescription is for a 30-day supply, the standard mail order copay is still applicable.&nbsp;Note that the specific quantity and days of supply may differ for each medication. Factors such as your provider's instructions, state and federal dispensing guidelines, or the packaging of the medication can influence the quantity and days of supply you are eligible to receive.

Can I choose to use an out-of-network pharmacy?

Yes. However, medication costs are lowest when you fill at a pharmacy that is part of your network. For participants in the State Employees' PPO Plan, filing a claim is an option, and reimbursement for the out-of-network provider benefit is possible, as outlined in the Benefits Document. However, if you are an HMO member, your access is limited to network prescription drug benefits, requiring you to cover the full cost of the medication from your own pocket&nbsp;

What if I do not want generic substitutions for my prescription?

If you opt for a preferred-brand drug when a generic alternative is accessible, you will be responsible for covering the price difference between the two, in addition to the applicable brand copayment or coinsurance.

What if I have manufacturers' discount cards or coupons?

You cannot use discount cards or coupons with the State of Florida&rsquo;s Prescription Drug Plan.

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Optum Rx Prescription Drug Plan FAQ

Optum RX is the Prescription Drug Plan administrator. The FAQs below will help you with questions you have concerning Optum RX.