• Prescription Drugs

Prescription Drug Coverage

Each of the medical plan options includes prescription drug coverage. The cost you pay per prescription is determined according to a five-tier drug classification designed to make your prescriptions more affordable—including certain generic medications for only $5.

Note: Under the Value HSA or Super Value HSA, you must satisfy your medical plan annual deductible before prescription drug coverage begins. However, you can use HSA funds to help pay for expenses applied toward your deductible. The tiers include:

Tier Description
Tier 1 Low-Cost Generics

You pay just $5 for any prescription drug in Tier 1. Tier 1 drugs contain the same active ingredients as their brand-name counterparts.
Tier 2 Higher-Cost Generics

These drugs contain the same active ingredients as their brand-name counterparts.
Tier 3 Preferred Brands

These drugs are primarily brand-name drugs without generic equivalents. In some cases, Tier 3 may also include generic drugs that have lower-cost or over-the-counter alternatives.
Tier 4 Non-Preferred Brands and Preferred Specialty

Tier 4 is primarily made up of preferred specialty drugs and non-preferred brand-name drugs. Tier 4 may also include some generic drugs that have lower-cost or over-the-counter alternatives available.
Tier 5 Non-Preferred Specialty

These drugs are in this tier due to the high cost of the medications. This tier includes higher-cost specialty drugs and may also include very high-cost brand and generic drugs.

Check Your Medication’s Tier

Visit www.harvardpilgrim.org/value5 to:

  • Access the Harvard Pilgrim drug lookup tool
  • Learn more about the Value 5-Tier prescription drug program
  • Get an up-to-date list of formulary medications

Learn More

Optum Rx

Rx Bin # 610011

855-258-1561

www.harvardpilgrim.org

Plan Documents

Retail90 Network

The Retail90 Network is a 90-day maintenance medication purchase-at-retail program. Interested members can obtain a 90-day supply of maintenance medications from a participating retail Retail90 Network pharmacy. This option does not enjoy the same copay savings as the mail order program, but provides an alternative method of obtaining 90-day prescriptions for maintenance medications when there is a barrier to receipt by mail. The copays for the Retail90 Network are three times the 30-day retail copay.

Many of the in-network pharmacies already available to you for your retail prescription purchases are available with Retail90 Network. Members can find local participating Retail90 Network pharmacies by using the Pharmacy Locator feature on the Harvard Pilgrim member website at www.harvardpilgrim.org.

Home Delivery Program

Save money on maintenance medications. OptumRx home delivery makes it easy, mailing right to your home. Once you’re set up in OptumRx home delivery’s system, an online refill service is available and there’s no charge for standard shipping. Opt to receive email and text alerts for refill reminders and order status updates—and even set up reminders for when it’s time to take your medications.

Get Three for the Price of Two!

When you use the home delivery program for tiers 1-3 drugs, you get a three-month supply of medication for the cost of a two-month supply. That’s four months of medication FREE per year!

Get Started

Go to www.harvardpilgrim.org. Once you are logged into your Harvard Pilgrim member account, click on “Check drug coverage & costs” and follow the prompts to access and register for OptumRx home delivery.

By Mail By phone electronic rx*
Have your doctors write you new 90-day prescription(s), with refills.

Download the order form from Harvard Pilgrim’s OptumRx home delivery website.

Complete the form and send along to OptumRx home delivery with your prescription(s).

 Call OptumRx home delivery 24/7 toll free at 855-258-1561. If your doctor is able to submit prescriptions electronically, ask
them to ePrescribe the prescription directly to OptumRx home delivery.

*By law, electronic prescriptions are valid only if sent from a prescriber’s office.

Note: Due to safety concerns, prescriptions for many controlled substances are not available through the home delivery program. These medications are covered when dispensed through participating retail pharmacies only and will be limited to a maximum quantity per prescription fill.

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