BENEFITS BASKET
The Catholic Health Prescription coverage carrier is OptumRx. For more information, please visit www.optumrx.com.
You can review the OptumRx formulary here to confirm coverage for you or your covered family member’s medications. For questions about your prescription drug benefits, please visit optumrx.com or call 1-844-642-9089.
Key Facts And Information About Your Prescription Plan
My CHS Rx Pharmacy
Copays and coinsurance are reduced when you use MyCHSRx Pharmacy. Elect to receive a 90-day supply and you will pay 2 MyCHSRx reduced copays for a 3-month supply.
You can pick up your prescription at any of the following inpatient pharmacies:
MyCHSRx also delivers to:
Home delivery is available if you are not working at any of the delivery locations or if you work from home.
MyCHSRx:
Coverage for Weight Loss GLP-1 Medications
Catholic Health has experienced a meteoric rise in the number of utilizers and associated costs with the coverage for GLP-1 medications prescribed for weight loss. This class of medications are those that you may have heard about that help lower blood sugar levels, and promote weight loss for people with obesity. The brands of GLP-1 medications used for weight loss are Zepbound, Saxenda and Wegovy.
This increase has drastically impacted our prescription claims experience, and without any type of intervention, it is estimated that all Catholic Health members would experience a significant increase in their health insurance premiums—regardless of whether an individual currently takes a GLP-1 medication. To mitigate this impact to health insurance premiums, Catholic Health has made the decision to discontinue coverage for new prior authorization approvals for GLP-1 medications specifically prescribed for weight loss effective 8/1/24. For anyone who currently has a prior authorization and is using one of these medications prescribed for weight loss, coverage will be discontinued as of 8/15/24.
GLP-1 medications prescribed for a diabetes diagnosis will continue to be covered.
We understand that weight management is a critical aspect of overall health. If you are currently using GLP-1 medications for weight loss, please refer to the letter you received from OptumRx with more detailed information.
This decision is based on a commitment to providing coverage for treatments with demonstrated clinical efficacy and value, while also managing healthcare costs responsibly. If you have any questions, you can review covered medications under the Catholic Health Plan online at www.optumrx.com or call OptumRx customer service at the number on your member ID card.
Get Help Managing Your Prescriptions and Save with US-Rx Care
US-Rx Care offers a voluntary pharmacy care management program that analyzes all of your prescription drugs and communicates with your doctor on your behalf regarding quality of care and cost-saving opportunities. This program is an enhancement to your existing pharmacy benefit plan. There are no copayment or formulary changes. If you have any questions regarding this program or would like to complete a proactive medication review, please contact US-Rx Care at 1-800-241-8440.
Prior Authorization and Quantity Management
Certain medications require additional approvals from your prescribing provider before they will be dispensed at your pharmacy. These medications tend to be very costly and may not always be the most appropriate choices for patients.
Other medications will be subject to quantity rules to avoid overuse or potential dependency (such as sleep medications). These programs represent an expansion of current rules already in place under the prescription drug benefit plan.
Generic Substitution
You will pay the co-payment plus the cost difference between the brand and generic drug if that brand is dispensed when a generic is available.
Notwithstanding anything on this website to the contrary, the prescription drug plan will not cover any costs or benefits that do not comply with the Ethical and Religious Directives of the Catholic Church.
For questions about your prescription drug benefits, please visit www.optumrx.com or call 1-844-642-9089.
Click here and then select Prescription Plan.
The information in this website is intended to provide highlights of the Benefits of Caring program, but in no way do the descriptions presented in this website supersede the provisions contained within the Catholic Health & Welfare Benefits Plan (the “Plan”), or the Plan’s Summary Plan Description, or any relevant insurance contract. In the event of any discrepancies, the actual provisions of the relevant insurance contract Plan document will prevail. Employees represented by a union should contact their union or HR benefits representative as applicable for benefit information. Catholic Health, in its sole discretion, reserves the right to amend or discontinue any or all of the benefits under the Plan and any or all of the programs within its Benefits Program at any time. Participation in the Benefits of Caring Program does not give you any right to continued employment. In addition, note that this Plan is intended and designed to be administered consistent with the tenets of the Catholic faith. Therefore, the Plan will not cover any costs or benefits that do not comply with the Ethical and Religious Directives of the Catholic Church.
