Prescription drug coverage is offered through Optum Rx.
As a leading pharmacy provider, Optum Rx offers affordable options, including mail order, 24/7 support, and a team of specialists to answer questions and help you manage your medications.
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Buy 2, get 3: A 90-day supply for maintenance medications (i.e., blood pressure, diabetes) lets you receive more medication for less, paying only two copays instead of three.
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Skip the trip: Optum Rx delivers prescriptions straight to your door, saving you time and money.
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Specialty meds, handled: Fill your specialty prescriptions at Optum Specialty Pharmacy. Your eligible current specialty prescriptions will automatically transfer. Learn more at specialty.optumrx.com/new-fill or 877.838.2907
Health Care Savings Medical Plan
| In-Network | Out-of-Network | |
|---|---|---|
| Rx Retail Copays | ||
| Generic | $20 copay after deductible | 50% coinsurance after deductible |
| Preferred Formulary | $40 copay after deductible | |
| Non-Preferred Formulary/Specialty | $60 copay after deductible | |
| GLP-1 Weight Loss Medication | $200 copay after deductible* | |
| Maintenance Rx (90-Day Supply) | ||
| Generic | $40 copay after deductible | Not covered |
| Preferred Formulary | $80 copay after deductible | |
| Non-Preferred Formulary/Specialty | $120 copay after deductible | |
| GLP-1 Weight Loss Medication | $400 copay after deductible* | |
| Home Delivery (90-Day Supply) | ||
| Generic | $40 copay after deductible | Not covered |
| Preferred Formulary | $80 copay after deductible | |
| Non-Preferred Formulary/Specialty | $120 copay after deductible | |
| GLP-1 Weight Loss Medication | $400 copay after deductible* | |
*The Benesch Medical Plan will apply a $20,000 lifetime maximum for GLP-1 medications prescribed for weight loss. Each participant’s plan-paid expenses for GLP-1 medications incurred on or after January 1, 2024 will count toward this lifetime maximum. Once the $20,000 lifetime maximum is reached, the plan will no longer provide coverage for GLP-1 medications in the weight-loss category.
PPO Medical Plan
| In-Network | Out-of-Network | |
|---|---|---|
| Rx Retail Copays | ||
| Generic | $20 copay | 50% coinsurance |
| Preferred Formulary | $40 copay | |
| Non-Preferred Formulary/Specialty | $60 copay | |
| GLP-1 Weight Loss Medication | $200 copay after deductible* | |
| Maintenance Rx (90-Day Supply) | ||
| Generic | $40 copay | Not covered |
| Preferred Formulary | $80 copay | |
| Non-Preferred Formulary/Specialty | $120 copay | |
| GLP-1 Weight Loss Medication | $400 copay after deductible* | |
| Home Delivery (90-Day Supply) | ||
| Generic | $40 copay | Not covered |
| Preferred Formulary | $80 copay | |
| Non-Preferred Formulary/Specialty | $120 copay | |
| GLP-1 Weight Loss Medication | $400 copay after deductible* | |
*The Benesch Medical Plan will apply a $20,000 lifetime maximum for GLP-1 medications prescribed for weight loss. Each participant’s plan-paid expenses for GLP-1 medications incurred on or after January 1, 2024 will count toward this lifetime maximum. Once the $20,000 lifetime maximum is reached, the plan will no longer provide coverage for GLP-1 medications in the weight-loss category.
Getting Started
Beginning October 1, Benesch employees may call 1.888.705.3125 with questions about the new pharmacy benefit plan. Please identify yourself as a Benesch employee when calling the number above.
- Visit welcome.optumrx.com/htctpremium
- If you currently take a medication that needs approval, that approval will not move to your new pharmacy benefit with Optum Rx.
- Optum Rx partners with SlateRx for coverage determinations. Certain medications may require a clinical review and approval before they can be filled.
- You may see these terms when you check your medications.
- PA (Prior Authorization): Your doctor must get approval before the prescription can be filled.
- ST (Step Therapy): You may need to try another medication first.
- QL (Quantity Limit): There are limits to how much of a medication you can fill at one time.
Register with Optum Rx
Beginning January 1, 2027, you can manage your medications anywhere, any time!
- Create an account at OptumRx.com
- Download the Optum Rx app
- Use your new Anthem ID card when filling prescriptions
- Set up your account with Optum Home Delivery Pharmacy if you use mail order
- Call Optum Rx at 800.765.6830 if you have questions
Home Delivery
Beginning January 1, 2027, you can easily manage your home delivery prescriptions. Visit OptumRx.com Or call 800.765.6830 to get started
- Your eligible current mail order prescription will automatically transfer to Optum Home Delivery Pharmacy.
- Compound medications, controlled substances, and prescriptions with no refills remaining will not automatically transfer and you may need to get a new prescription.
- You can also fill your 90-day prescriptions at your local pharmacy.