Pharmacy Information

OptumRx®

Starting January 1, 2020, OptumRx will manage pharmacy care services for WHA members.


Express Scripts 

Express Scripts will continue to manage pharmacy care services for WHA members through December 31, 2019.

Preferred Drug List

PRESCRIPTION DRUG SEARCH
 
Select one of the following criteria to search for covered prescription drugs.

 

 

Prescription Coverage

Your copayment summary will help you determine whether your prescription coverage uses the three or four tier plan. It is important to note that prescription coverage may be subject to pharmaceutical management (for example, prior authorization). Additionally, there are a small number of drugs, regardless of tier, that may require prior authorization to ensure appropriate use.

Three-tier Plan

  1. Preferred generic medications listed on the Preferred Drug List are covered at the lowest tier copayment level
  2. Preferred brand name medications listed on the Preferred Drug List are provided at the second tier copayment level
  3. Non-preferred drugs listed on the Preferred Drug List are covered at the third tier copayment level

Unique cost shares apply for self-injectable medications, and medications for the treatment of infertility (if covered) and erectile dysfunction (see copayment summary)

Four-tier Plan

  1. Preferred generic medications listed on the Preferred Drug List are covered at the lowest tier copayment level
  2. Preferred brand name medications listed on the Preferred Drug List are provided at the second tier copayment level
  3. Non-preferred drugs listed on the Preferred Drug List are covered at the third tier copayment level
  4. Specialty medications are covered at the fourth tier copayment level

Prescription Costs

Not all medical plans have prescription coverage. If you have prescription coverage, you will pay the lesser of the retail price, or cost sharing as described below, for any prescription, retail or mail order. Refer to your copayment summary for additional details.

Copay Plans

  1. Use WHA's prescription drug search to find the medication listed on the Preferred Drug List
  2. Identify the medication's tier
  3. Refer to your copayment summary for the copayment that is associated with that tier

Deductible Plans

  1. Refer to your copayment summary to determine if prescriptions are subject to a deductible on your plan
  2. Use Express Scripts' pricing tool to price a prescription medication under the deductible. If your group plan offers infertility coverage, use Express Scripts' pricing tool with infertility.
  3. Once your deductible has been met, refer to the instructions for copay plans to determine your share of costs

Pharmacy Options
 

Retail Pharmacies

You can obtain most of your prescription medications at any participating retail pharmacy. Find a participating retail pharmacy by visiting Express Scripts online or by calling 800.903.8664.

Members can also gain direct access to Express Scripts by logging into their MyWHA account and choosing Connect to My Pharmacy from your My Resources toolbar. 

Mail Order

Save time and money by ordering a 90-day supply through Express Scripts' mail-order program. Your prescription can be refilled by phone or online and will be delivered straight to your home or office.

Specialty Network

Specialty medications can be obtained through WHA's exclusive specialty pharmacy network:

  • Accredo (Express Scripts' specialty pharmacy)
  • UC Davis
  • Dignity Health 

WHA will allow up to two initial fills at local retail pharmacies to make sure you get started on your medications in a timely manner. All other fills will be limited to WHA’s specialty network. For convenience, some specialty medication refills can be ordered online at express-scripts.com or by calling Accredo at 877.895.9697.


Express Scripts Member Services

Express Scripts Member Services is available 24 hours a day, 7 days a week by calling toll-free at 800.903.8664.

Online Services

  • Order refills and renew prescriptions easily
  • View up to 12 months of prescription history
  • Review pharmacy benefit plan highlights
  • Compare prescription coverage and pricing
  • Access health and wellness information 24/7

To access Express Scripts by TTY
TTY is available for hearing-impaired members by calling 800.759.1089

To order prescription labels printed in Braille
Braille labels are available for mail-order prescriptions. Call 800.903.8664