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Prescription Drug Information

NetCare members have access to pharmacies on Guam, Saipan, Hawaii and the Continental United States through the OPTUMRX Pharmacy Network. Regular prescription drug co-payments will apply when accessing participating pharmacies.

To locate a pharmacy closest to you on Guam, CNMI, Hawaii or the Continental U.S., please call the OPTUMRX Customer Service toll free number at 1-877-559-2955. The pharmacy will need the numbers listed on the back of your member identification card in order to process your prescription electronically. For additional information, you can log on to www.optumrx.com

What is the Preferred Product List (PPL)?

The Preferred Product List is a list of the most common brand and generic prescription medications available at participating pharmacies. This is an abbreviated list and does not include every medication. All generics are covered at the First Tier whether listed or not. All brand medications are listed in the Second Tier; all non-preferred or non-formulary drugs are listed under the Third Tier; and all injectibles are listed under the Fourth Tier. This list is subject to change based on the review and recommendation of the OPTUMRX independent review committee meedt regularly to consider new and existing prescription medications for inclusion in the PPL.

For further information on your prescription coverage, please refer to your Summary of Plan Description or Summary of Benefits. For questions about product status or if the product does not appear on the PPL, please call OPTUMRX Customer Service at 1-877-559-2955 Toll Free, 24 hours a day, 7 days a week.

What is the difference between brand name, generic medications, and non-formulary or non-preferred drugs?

A generic medication is a copy of a brand-name medication. The color or shape may be difference, but the active ingredients must be the same for both. Generic medications must meet the same quality standards as brand-name medications. A Non-Formulary or non-preferred medication is a drug that is not listed in the Preferred Product List due primarily to the high cost of the drug. The FDA sets these standards and reviews all medications before they are marked. Your coverage for brand-name drugs where a generic is available may vary.

Required Information for Drug Processing

The following information is required for the pharmacy provider to process your prescription claims:

  1. Rx Bin: 610127
  2. Rx PCN: 02330000
  3. Rx Group: 02330075

**FOR ALL PRESCRIPTION DRUG PRIOR-AUTHORIZATION REQUESTS, PLEASE CALL THE OPTUMRX CUSTOMER SERVICE LINE AT 877-955-2955 (AVAILABLE 24-HOURS/DAY)**

Preferred Product List
Prior Authorization
Quantity Limits on Medications
Specialty Drugs


The OPTUMRX Preferred Products List is updated monthly. To access the most recent PPL and for further information, please visit www.optumrx.com

Specific Prescription Policy Changes

Angiotensin Receptor Blockers 1
Angiotensin Receptor Blockers 2
Antihistamines 1 Daily
Antihistamines 2 Daily
Finasteride DACON
Lexapro DACON
Nasal Steroids QL 2 per Month
Plavix DACON

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