Optum Rx®
Optum Rx is our pharmacy partner and provides you with 24/7 access to pharmacists, online and mobile app prescription management, and tools to find pharmacies. Use the Optum Rx mobile app (Apple® App Store®, Google Play™) or optumrx.com to help manage your medications. You’ll be able to find a network pharmacy, check medication coverage, track home delivery orders and more. You can even sign up to receive text messages that remind you when it’s time to refill or take your medication.
Getting Started
Already a Member?
Get started by logging into your MyWHA account (click the Login | Register link at the top right of the page). Once logged in, you’ll have one-click access to your personalized Optum Rx portal. Note: The first time accessing Optum Rx you will have to complete a one-time registration process in addition to your MyWHA account.
Shopping for Coverage?
Preferred Drug List - 2024 Plans
To learn if your medication is covered, search WHA's preferred drug list for covered prescription drugs, using the green button below. You can also download a PDF of the 3-Tier or 4-Tier Prescription Drug Plan.
Preferred Drug List - 2025 Plans
For benefit plans in 2025, WHA is excited to roll out two new and innovative formularies: the Premium Formulary for all employer group members, and the Essential Health Benefits (EHB) Formulary for individual and family plans. Use the same Prescription Drug Search button below to view specific information, but make sure to select a 2025 plan option to see the new changes.
Pharmacy Options
Retail Pharmacies: Fill your prescription at one of the thousands of participating retail pharmacies. Maintenance medications commonly used in the treatment of chronic conditions, like arthritis, high blood pressure, heart conditions and diabetes, are eligible for a 90-day supply per fill or refill, currently through the Select90 program at Walgreens or CVS pharmacies. Effective on January 1, 2025, members can fill 90-day supply prescriptions from any participating pharmacy upon renewal of your plan.
Mail Order: Save time and money by obtaining a 90-day supply of the medications you take regularly through Optum Rx’s mail-order pharmacy program. Effective January 1, 2025, WHA is excited to expand this program to offer up to a 100-day supply with OptumRx mail-order pharmacy upon renewal of your plan.
Specialty Pharmacy: Get help managing your condition and have your medications delivered, at no extra cost by using OptumRx Specialty Pharmacy.
Pricing Tool
Use Optum Rx’s drug pricing tool to look up a drug and find information and pricing at nearby pharmacies. Learn how to determine what prescription drug plan is included in your coverage. Make sure to select the plan option for 2024 or 2025 plans so you see the most accurate information.
Transfer Prescriptions with Ease
Follow these 5 easy steps to transfer an existing prescription and establish care with a pharmacy convenient to you.
Prescription Coverage
2025 Plans - WHA is transitioning its prescription drug benefits to a Premium Formulary and Essential Health Benefits Formulary effective January 1, 2025. This is a proactive move for WHA to bend the trend of managing prescription costs more effectively for our members, while also maintaining accessibility to necessary medications. WHA is a health plan built on access and affordability. With this move, we’ve developed the right balance in our Pharmacy Benefits with OptumRx, enabling us to maintain options selected for clinical effectiveness, while still providing access to affordable medications and lower-cost alternatives. This also allows WHA to remain aligned with industry best practices and trends. Learn more by visiting the 2025 Formulary resources page here.
2024 Plans - Your copayment summary for plans with an annual renewal date in 2024 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 (2024)
- Preferred generic medications listed on the Preferred Drug List are covered at the lowest tier copayment level
- Preferred brand name medications listed on the Preferred Drug List are provided at the second-tier copayment level
- Non-preferred drugs listed on the Preferred Drug List are covered at the third-tier copayment level
Note: 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 (2024)
- Preferred generic medications and certain preferred brand-name medications listed on the Preferred Drug List are covered at the lowest tier copayment level
- Preferred brand name medications and certain non-preferred generic medications listed on the Preferred Drug List are provided at the second tier copayment level
- Non-preferred drugs listed on the Preferred Drug List are covered at the third tier copayment level
- Specialty medications, drugs that require special training or clinical monitoring, and drugs that cost more than $600 per month are covered at the fourth tier copayment level
Note: Unique cost shares apply for medications for the treatment of infertility (if covered) and erectile dysfunction (see copayment summary for more information)
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
- Use WHA's prescription drug search to find the medication listed on the Preferred Drug List
- Identify the medication's tier
- Refer to your copayment summary for the copayment that is associated with that tier
Deductible Plans
- Refer to your copayment summary to determine if prescriptions are subject to a deductible on your plan
- Use OptumRx's pricing tool to price a prescription medication under the deductible.
- Once your deductible has been met, refer to the instructions for copay plans to determine your share of costs
On January 1, 2025, the cost or coverage of your current medication may change. If you are currently taking appropriately prescribed medication and your health care provider continues to prescribe this medication for you, you may remain on this medication, in accordance with state law. However, the medication may be subject to placement on a different tier resulting in a change in cost sharing. Speak to your provider regarding medication options under the new formulary or visit our pharmacy website for more information.
Drug Recalls and Withdrawals
Western Health Advantage is committed to ensuring our members and providers have access to FDA-issued drug recall and withdrawal information. For recall question, please contact WHA Member Services toll-free at
(888) 563-2250.
For a current list of Class 1 drug recalls and withdrawals, please see our Drug Recalls and Withdrawals webpage.
Contact Information
For assistance with mail order/home delivery or specialty medication:
Optum Rx Call (toll free): 844.568.4150
Optum Rx Specialty Pharmacy: 855.427.4682
For assistance with benefits and coverage:
WHA Member Services: 888.563.2250
For assistance with medication prior authorization:
Prescription Requests: 916.568.5280 fax