Pharmacy Benefits 2024-2025

Student Health Insurance Plan Pharmacy Benefit

Use UnitedHealthcare (OptumRx) participating pharmacies and present your insurance ID card.

  • To find a participating pharmacy, visit www.uhcsr.com/arizona and select Find Pharmacy.
  • Policy Year Pharmacy Deductible: $125
  • Preferred Care Policy Year Out-of-Pocket Maximum: Combined Medical & Pharmacy $1,500 (includes copayments, deductible, and coinsurance)
  • Additional UnitedHealthcare prescription drug/Rx information can be found at www.uhcsr.com/arizona under Helpful Links.

Prescription Copay Schedule

  • Tier 1: $15 copay
  • Tier 2: $40 copay
  • Tier 3: $80 copay

Note: Copays for prescriptions apply once the pharmacy deductible of $125 has been met for the policy year. 

Contraceptives

Generic contraceptives are covered at 100%.

Note: Brand-name contraceptive prescription drugs or devices from a preferred provider will be covered at 100% of the negotiated charge, including waiver of per policy year pharmacy deductible if a generic contraceptive prescription drug or device is not available in the same therapeutic drug class or the prescriber specifies dispense as written.

Transition of Care

Transition of Care for medications/prescriptions that require Prior Authorization, Step Therapy, or Specialty Pharmacy: Please call the Optum Transition of Care team at 1-800-356-3477 or sign into your UHCSR "My Account".