COMING SOON: Explore benefits and coverage for our federal health plans.
Open Season 2026
Optum Rx provides pharmacy benefits and offers a network of 67,000+ pharmacies, including national chains, local pharmacies, home delivery, and specialty drugs.
NEW for 2027: The plan now covers GLP-1 drugs for weight loss at 50% per prescription
Consumer Driven Option prescription coverage
Network retail
Tier 1/Tier 2
Lower cost/Mid-range cost
Tier 3
Highest cost
In-network you pay
25% ($15 min/$200 max) for a 30-day supply per Rx
$400 for a 60-day supply per Rx
$600 for a 90-day supply per Rx
40% ($15 min/$300 max) for a 30-day supply per Rx
$600 for a 60-day supply per Rx
$900 for a 90-day supply per Rx
Network home delivery
Tier 1/Tier 2
Lower cost/Mid-range cost
Tier 3
Highest cost
25% ($10 min/$200 max) for a 30-day supply per Rx
$400 for a 60-day supply per Rx
$600 for a 90-day supply per Rx
40% ($10 min/$300 max) for a 30-day supply per Rx
$600 for a 60-day supply per Rx
$900 for a 90-day supply per Rx
Visit the Optum RX drug pricing tool.
During your deductible phase, members are responsible for the total cost of medication.
Your Personal Care Account (PCA) covers 100% of eligible expenses, including prescription drugs. If you fill a prescription when you have benefit dollars available in your PCA, the funds will be applied, and you’ll pay nothing.
Receive a discount when you use Optum Rx Home Delivery. When you order or refill a prescription by mail, the discounted cost of the medication will be subtracted from your PCA.
Federal Health Plans
COMING SOON: Explore benefits and coverage for our federal health plans.
High Option
Consumer Driven Option
Federal Health Plans
View a summary of benefits and coverage (SBC) for your plan.
Consumer Driven Option
All Health Plans
COMING SOON: View a list of prescription drugs covered by your health plan.
Consumer Driven Option
DEFINITION
Receive a $25 wellness incentive added to your PCA for each family member who completes a yearly checkup or recommended screening.
DEFINITION
15% coinsurance: The percentage of costs you pay after you pay the deductible.
DEFINITION
A Copay is a fixed amount you pay for a covered healthcare service, usually at the time you receive the service.
DEFINITION
Plan allowance is the maximum amount a plan will pay for a covered healthcare service
