All Princeton medical plans include prescription coverage through OptumRx. The prescription plan is a formulary design; a formulary is a list of prescribed medications — both generic and brand-name — that have proven to be both clinically and cost effective.
Individuals enrolled in the Consumer Directed Health Plan (CDHP) have coverage after the deductible is met. Exceptions for immediate coverage are preventive drugs and IRS-designated drugs for chronic conditions. For all other Princeton medical plans, coverage begins immediately.
- There are no additional premiums for this plan; coverage is included with your medical plan.
- The formulary has three tiers that provide a different level of coverage. A product covered at the highest level is available in every therapeutic class.
- Mail order is available at a reduced cost.
- Certain prevention prescriptions and contraceptives are covered at 100%, including generic, preferred brand drugs, and some over-the-counter (OTC) drugs (prescription required).
- The OptumRx mobile app provides easy, on-the-go access to a member’s personalized health information and prescriptions.
- Members are required to create a HealthSafe ID when creating an online account. This ID number allows members to securely access their prescription and personal information with OptumRx.
- Over-the-counter (OTC) at-home diagnostic COVID-19 tests will be covered at a copay of $5 per test if purchased through OptumRx or an in-network pharmacy. Up to four tests per member, per month will be covered. For example, if you purchase a kit with two tests, the copay will be $10. If an OTC at-home COVID-19 test is purchased out-of-network, OptumRx will provide a reimbursement of up to $5 per test, up to four tests per member, per month.
To minimize costs, consider the following:
- Participants taking certain prescriptions on a monthly basis can purchase a three-month supply through mail order at the same cost as a two-month supply at retail. Home delivery provides automatic refills of medication. Contact OptumRx to make arrangements or complete the mail order form.
- If a prescription is not a generic or preferred medication on the formulary, contact OptumRx to find the best way to minimize costs.
$40 or member pays the difference
$80 or member pays the difference
If there are any discrepancies between the information in this publication, verbal representations, and the plan documents, the plan documents always govern. Although Princeton intends to continue these benefits, the University reserves the right to amend or terminate these plans at any time.