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".