Prescription Claims

2023-2024 Plan Year

REFILLS DURING OPEN ENROLLMENT

To have continual access to prescriptions, you must have prescription refills available and you must accept the Premier Plan at least 15 days before the effective date of the new Plan Year.

SUBSCRIBER NUMBER

Your nine digit GUID/GoCard number beginning with an “8” is your Premier Plan health insurance subscriber number.

ACCESSING PHARMACY DISCOUNTS WITH YOUR ID CARD

Present your ID card at United HealthCare Network Pharmacies and pay only the co-payment or co-insurance to access the discount prescription drug benefit. 

If instead of using your pharmacy card to purchase a prescription, you pay for the prescription drugs in full at the retail price and submit a prescription claim form; the plan will apply the applicable Co-payment or Co-insurance and reimburse you at the discount price, not the retail price. You will be responsible for prescription drug payments in excess of the discounted price.

PRESCRIPTION DEDUCTIBLE, CO-PAYMENTS, and CO-INSURANCE

After a separate $150 Prescription Plan Year Deductible, a $15 Co-payment applies to Tier 1 medications and 20% Co-insurance applies to Tier 2 and 3 medications.  Tier assignments are subject to change for any given prescription drug as bulk discounts change.  To determine the payment, call the pharmacy network at 1-855-828-7716.

PRIOR AUTHORIZATION FOR SPECIFIC PRESCRIPTIONS

Prior-authorization for purchasing specific medications has become an industry standard and is required under the Premier Plan.   If you receive correspondence about Prior Authorization, you will need to consult your doctor to determine if other medication would be appropriate.  Otherwise, Prior Authorization must be obtained to continue taking that specific medication.   Prescribers have access to United’s Prior Authorization tools to ensure that the right medication, dose, and duration is dispensed for each member. 

Your doctor may submit information for a Prior Authorization by visiting:

• www.uhcprovider.com and clicking on the Prior Authorization…purple tile
• www.uhcprovder.com and accessing the provider’s LINK account, or
• https://professionals.optumrx.com/prior-authorization.html  as an out-of-network provider

Members may access the RX Drug List on UHCSR’s website to identify what medications require Prior Authorization (PA).

CONTRACEPTIVE COVERAGE

Georgetown University has certified that this student health insurance plan qualifies for an accommodation with respect to the Federal requirement to cover all Food and Drug-administration approved contraceptive services for women, as prescribed by a health care provider, without cost sharing.  This means that Georgetown will not contract, arrange, pay or refer for contraceptive coverage.  The accommodation remains in place, thereby, UnitedHealthcare will continue to provide separate payments for contraceptive services that you use, without cost sharing and at no other cost, for so long as participants are enrolled in this plan.  Georgetown University will not administer or fund these payments.

Contraceptives for medical conditions for which such medicatons are indicated are prescribed by physicians and nurse practitioners at Georgetown Student Health Center.  See the Student Health Center website FAQs for more information.

PRESCRIPTION EXTENSION REQUEST FORM

To request an extension of prescription coverage beyond an authorized 30 day supply due to traveling outside of the United States, download a Prescription (RX) Extension Request Form from the Arthur J. Gallagher & Co., Student Health & Special Risk Web site.