OptumRx: New Pharmacy Benefit Manager for a New Year


CHI Saint Joseph Health

Starting Jan 1, 2020, OptumRx will be your new pharmacy benefit manager. There’s no action required on your part, and this does not change your pharmacy benefits for 2019. Through the end of this calendar year, you can continue to fill your prescriptions at any CHI pharmacy (like our community pharmacy at Saint Joseph East), via CVS Caremark mail order, or at a CVS Caremark network pharmacy.

When we make the change to OptumRx, you’ll have access to a large network of retail pharmacies – including national chains and local pharmacies – and the ability to fill maintenance medications through mail order services. Both CHI and OptumRx are dedicated to making this transition easy for you. During the next few months, we’ll send you helpful information so you can feel confident managing your medications.

Here are three things you need to know about your prescription coverage for 2020:

  • The benefit plan design is not changing. The coverage amount is not changing. However, the formulary list will be updated (as it is every year) and you may see changes in cost because of that.
  • In mid-to-late December, your medical plan administrator will send you a new medical card with updated pharmacy information.
  •  Specialty prescriptions must be processed through the CHI Health Specialty Pharmacy.*
We know that managing your pharmacy benefits can be confusing, so OptumRx will be ready to support you and provide the tools you need to navigate your pharmacy benefit. You’ll receive more information when our Annual Enrollment site opens on Sept. 25.

*There may be situations in which the CHI Health Specialty Pharmacy cannot fill your specialty medication; when that situation exists, CHI Health Specialty Pharmacy will route the specialty medication prescription to the OptumRx specialty pharmacy, BriovaRx.