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Prescription Plan

OptumRx administers the pharmacy benefit for both medical plans.

ICUBA Prescription Drug Program Overview

The pharmacy benefit is separate from the medical plans but included in the medical premiums. A separate identification card is issued for pharmacy benefits. 

Members may choose from thousands of retail in-network pharmacies nationwide. There are three ways to fill a prescription (each with a different copay): 30 days supply at the retail pharmacy; 90 days supply at the retail pharmacy; or 90 days supply through mail order.

Pharmacy Benefits Summary (2021-2022)

Prescription Copays

The following in network prescription co-pays apply:

Retail (Up to a 30-day supply)

  • Preferred Generic - $5.00
  • Non-Preferred Generic - $10.00
  • Preferred Brand - $40.00
  • Non-Preferred Brand - $75.00

Retail (Up to a 90-day supply) - Through the Prescription Drug Program, members can receive their 90-day prescriptions at participating retail pharmacies as well as mail service. Your doctor must authorize a 90-day supply of medication. Most pharmacies in the plan participate in this benefit.

  • Preferred Generic - $10.00
  • Non-Preferred Generic - $20.00
  • Preferred Brand - $80.00
  • Non-Preferred Brand - $150.00

Mail Service (Up to a 90-day supply) - Through the Prescription Drug Program, you can take advantage of convenient delivery of your covered maintenance medications to your home or other given address. Before you begin using your mail service pharmacy benefit, you must register by visiting the OptumRx website through the ICUBA website.

  • Preferred Generic - $10.00
  • Non-Preferred Generic - $20.00
  • Preferred Brand - $80.00
  • Non-Preferred Brand - $150.00

*Member will be required to pay the difference in cost between a brand and generic drug if request a brand when a generic equivalent is available. Otherwise, brand name drugs will be billed at the applicable brand name copayment level.

**A formulary is a list of medications that can help you maximize your benefit by minimizing your prescription costs. The Formulary Guide may be accessed by visiting the OptumRx website through the ICUBA website.

Note: Effective 1/1/2019, prescription drugs that have an over-the-counter equivalent will no longer be covered under the plan. 

Specialty Medications (Up to a 90-day supply) - High-cost prescription medications used to treat complex, chronic conditions like cancer, RA and MS. Special handling (like refrigeration during shipping) and administration (such as injection or infusion) are required.  Specialty medications under ICUBA’s Rx plan are only provided through Optum’s specialty partner, Briova.

  • Preferred Specialty - $75.00
  • Non-Preferred Specialty - $75.00 (manufacturer rebates will not be accepted)

Optum Rx Health Care Advisors

If you have a question about your pharmacy benefits (for example, copayment, eligibility, or location of a nearby participating pharmacy), call Member Services toll-free at 1-855-811-2213.

ICUBAcares Pharmacist Advocate Program

Our ICUBAcares Pharmacist Advocate Program (PAP) is comprised of licensed pharmacists who are Real Advocates with Real Solutions! 

  • Closing gaps in care attributed to Prior Authorizations, Quantity Limits, Step Therapy and Generic Drug Requirements
  • Assist members with formulary changes
  • Serve as a liaison between doctors, pharmacy and insurance company
  • Assist members to use therapeutically appropriate, cost-effective therapy

ICUBAcares will make outbound phone calls to members and offer services and assistance as a Pharmacist Advocate. Members can also make inbound calls to a real pharmacist if a question arises. Speak with a pharmacist directly, and have your personal questions answered over the telephone.

Contact ICUBAcares at 1-877-286-3967 

Free Over The Counter (OTC) Preventive Generics

The generic preventive OTC medications listed below are covered as part of your pharmacy benefit with zero dollar copay! Simply bring your physician's prescription for the medication along with the generic medication being prescribed to the pharmacy counter. The pharmacy can process the medication through your OptumRx pharmacy benefit. Below is a description of the preventive OTC medications that will be covered.

Only generic versions of these medications will be covered, and a prescription is required:

  • Iron supplementation for babies
  • Prenatal generic vitamins or folic acid for all women planning or capable of pregnancy
  • Oral fluoride supplementation for children
  • Aspirin for adults

For more information on this benefit, please visit the ICUBA Benefits site and visit the Reference Center.