Prescription Drug Benefits

Overview of the prescription drug benefits available as part of ERIE's benefits package.

Download Prescription Drug Chart

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Claims Administrator: OptumRx®/OptumRx® Specialty Pharmacy

Website: myuhc.com | Phone: 1-888-651-7322

  • Coverage is included if enrolled in a health protection plan.
  • Prior authorization may be required.
  • In Health1 and Health2, you pay a copayment or coinsurance amount for each prescription. In the CDHP, you pay the full cost of the prescription until your deductible is met, and then coinsurance begins.
  • Save by using formulary[1] and generic drugs (automatically substituted, when available).
  • Obtain up to a 90-day supply at a network retail pharmacy or through OptumRx Mail Service Pharmacy.
  • Maintenance medications are available through mail service for a 90-day supply and refills for up to a year.
  • Specialty medications must be obtained through OptumRx Specialty Pharmacy.
  • A $100 benefit threshold applies to each compound prescription.
  • The plan does not cover over-the-counter medications or certain prescription medications that are also available over the counter.

What you pay per prescription

OptumRx Prescription Benefit Program Value Pharmacy Network[2]
Retail Drugs  
Mail Order
Specialty Medication OptumRx Specialty Pharmacy[3]
OptumRx Prescription Benefit Program Value Pharmacy Network[2]
Retail Drugs  
Obtain up to a 90-day supply (cost per 30-day supply)
Mail Order
Obtain up to a 90-day supply (cost per 90-day supply)
Specialty Medication OptumRx Specialty Pharmacy[3]
Obtain up to a 90-day supply (cost per 30-day supply)
OptumRx Prescription Benefit Program Value Pharmacy Network[2]
Generic
Retail Drugs  
20%  
Mail Order
20%  
Specialty Medication OptumRx Specialty Pharmacy[3]
50%  
OptumRx Prescription Benefit Program Value Pharmacy Network[2]
Brand - formulary
Retail Drugs  
20%  
Mail Order
20%  
Specialty Medication OptumRx Specialty Pharmacy[3]
50%  
OptumRx Prescription Benefit Program Value Pharmacy Network[2]
Brand - non-formulary
Retail Drugs  
50%  
Mail Order
50%  
Specialty Medication OptumRx Specialty Pharmacy[3]
50%  
OptumRx Prescription Benefit Program Value Pharmacy Network[2]
Copayment minimum
Retail Drugs  
$10  
Mail Order
$20  
Specialty Medication OptumRx Specialty Pharmacy[3]
$10  
OptumRx Prescription Benefit Program Value Pharmacy Network[2]
Copayment maximum
Retail Drugs  
$50  
Mail Order
$100  
Specialty Medication OptumRx Specialty Pharmacy[3]
$50

In Health1 and Health2 plan options only: Once your annual out-of-pocket prescription expenses reach $5,600 for an individual or $11,200 for a family in Health1, or $4,100 for an individual or $9,200 for a family in Health2, the plan pays further eligible prescription expenses at 100% for the rest of the calendar year.

  1. 1. 

    A formulary is a list of drugs developed by UHC's Pharmacy and Therapeutics committee that are deemed to be clinically therapeutic and less expensive than other similar brands of medication.

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  2. 2. 

    Prescriptions are covered as long as they are listed on the prescription drug formulary. Under the mandatory generic provision, you are responsible for the payment differential when a generic drug is available and you specify a brand-name drug. Your payment is the price difference between the brand-name drug and the generic drug in addition to the brand-name drug coinsurance amounts, which may apply. Not to exceed the total cost of the brand-name drug.

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  3. 3. 

    Certain medications, such as self-administered injectables, biological agents, biotechnology medications and other prescriptions that are not available at most pharmacies, will be provided exclusively through OptumRx Specialty Pharmacy.

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