Pharmacy
Effective January 1, 2021, changes will be occurring with our Optima Health prescription drug plan that may impact you or another family member on your plan. Optima Health will also be sending a letter to members that are directly impacted by these changes.
Optima Health will be providing a listing of medications that fall into each of these categories. The formulary drug list is available at www.optimahealth.com/members.
- Click Manage My Plan
- Select Prescription Drug Lists on the right-hand side
- Click Employer Plans
- Select Open Drug Formulary (2020)
You may also sign into your member account to access your specific pharmacy coverage and resources.
Click here - Pharmacy Changes Effective January 1, 2021
- Weight Loss Medication: Prescription weight loss drugs will require authorization annually. You will not be able to fill a prescription unless your prescribing doctor has submitted the required paperwork to Optima Health. You will be limited to a one month’s supply per refill from the pharmacy. Weight loss medications are intended for short term use and may have serious health consequences if used for a long period.
- Over the Counter Medications: These will no longer be covered under the health plan, but you may continue to purchase these at the retailer of your choice.
- Preventive Medication Coverage: Some prescriptions will no longer be on the preventive medications list with 100% coverage. You may continue receiving these medications under the health plan coverage, but you will be responsible for the appropriate tier copayment. Likewise, there will be some new medications to the preventive medication list. Please visit the dedicated Optima Health website at optimahealth.com/nnva. The new preventive medication list will be posted soon.
- Tier Changes and Formulary Changes: Some medications may move between tiers (for example, previously Tier 1, now on Tier 2). Again, you may continue receiving these medications under the health plan coverage, and you will be responsible for the appropriate tier copayment. If the drug you are taking is not on the Formulary, you may work with your physician to find an alternative on the Formulary.
It is important for you to discuss your prescription drug options with your doctor. If you have any questions about changes in your prescription drug benefit, or other questions about your healthcare plan, please contact Optima Health Member Services at (800) 229-1199.