Prescription Drug Plan


All Princeton medical plans provide prescription coverage through Catamaran, an OptumRx company (OptumRx). Coverage varies depending on your medical plan election.  

If You Choose:

Then:

Consumer Directed Health Plan (CDHP)

Coverage is provided after the medical plan’s annual deductible(s) are met. Exceptions for immediate coverage are preventive drugs and IRS designated drugs for chronic conditions.   

All other Princeton Medical Plans

Coverage begins immediately regardless of meeting your medical plan’s deductible.

You pay for your prescriptions with a copayment that is determined by the formulary and whether you use a retail pharmacy or the lower cost mail order program. A formulary is a list of prescribed medications that have proven to be both clinically and cost effective. Prescriptions on the formulary are categorized into three tiers and those tiers determine your cost for a medication. Some prescriptions may be excluded from the formulary. There are preferred products in every therapeutic class in the formulary.  

There is a prior authorization process for clinical exceptions through OptumRx. As an example, if you are taking a non-preferred or excluded medication due to an allergic reaction to the preferred brand equivalent, your provider will need to file a prior authorization with OptumRx. If the prior authorization is approved, you will only be responsible to pay the preferred brand copay.

For information about your prescription benefits visit the OptumRx website or call OptumRx member services at (877) 629-3117.

 
Retail Pharmacy (30-Day Supply)
Mail Order (90-Day Supply)
Generic
$5 copayment
$10 copayment
Preferred Brand
$25 copayment
$50 copayment

Non-Preferred Brand

$40 or member pays the difference
$80 or member pays the difference
 
Infertility Coverage (oral and injectable medication): Same as above up to a $20,000 lifetime maximum.
 
Specialty Medications: Some specialty medications are not covered at a retail pharmacy and may be purchased only through OptumRx Specialty Pharmacy Briova. To enroll or learn more about Briova, call (855) 427-4682 or visit the BriovaRx website.
 
You will receive a separate ID card for the prescription drug program administered through OptumRx.
 
If you need to purchase a prescription at a participating retail pharmacy before you receive your ID card, you can contact OptumRx or you may print a temporary card from the OptumRx website. Provide the pharmacist with the following information: 
 
Provider:
OptumRx
Member ID #:
Will be system generated by Princeton
Phone number:
(877) 629-3117
 
If your name does not appear in the system yet, you should pay for your prescription, and then submit the receipt along with the OptumRx claim form to OptumRx. 
 
Princeton University participates in Prior Authorization, Step Therapy, and Quantity Duration Programs for certain prescribed medications. An OptumRx pharmacist may need to speak with the prescribing physician to ensure that the patient meets the criteria for the prescription prescribed.  In addition, the quantity of some prescription medications may be limited based on FDA regulations ensuring patient safety.  If your physician deems it necessary for your care and treatment, he or she may appeal OptumRx's decision.

Healthy Savings!

Through OptumRx by Mail, prescriptions are delivered to your home, and you can get a 90-day supply of maintenance medications for the cost of a 60-day supply purchased at a retail pharmacy.
 
There is a Home Delivery Incentive Program through OptumRx by Mail for participants who are on maintenance medication.  If you fill your maintenance prescriptions through Optum Rx Home Delivery Service (mail order), you will receive a three-month (90-day) supply for the cost of a two-month (60-day) supply.  However, if you renew your prescription for maintenance medication through a retail pharmacy for more than three months, subsequent refills will cost twice the retail pharmacy copayment rate.
 
 
You can count on support from knowledgeable and responsive HR staff when you have a benefits question or problem. Just call or e-mail us. We’re here to help!