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  • Tier Cost Sharing Request Form - Optumrx

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Please note: All information below is required to process this request MonFri: 5am to10pm Pacific / Sat: 6am to 3pm Pacific For real time submission 24/7 visit www.OptumRx.com and click Health Care.

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Medicare must approve the Medicare Part D Prescription Drug Plan, administered by Optum Rx, each year. You can continue to get Medicare coverage as a member of our plan as we choose to continue to offer the plan and Medicare renews its approval of the plan.

There are typically three or four tiers: Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs.

You can submit your order via phone, mail, online or through the OptumRx App. Additionally, your physician can electronically submit your prescription to OptumRx.

Level or Tier 1: Low-cost generic and brand-name drugs. Level or Tier 2: Higher-cost generic and brand-name drugs. Level or Tier 3: High-cost, mostly brand-name drugs that may have generic or brand-name alternatives in Levels 1 or 2. Level or Tier 4: Highest-cost, mostly brand-name drugs.

Tier 3 – Non-preferred brand name medications in which you will incur the highest amount of out-of-pocket costs.

Members can get a paper copy of the directory at no cost by calling the phone number on their ID card. Paper copies are not available to non-members. All network pharmacies must meet National Committee for Quality Assurance credentialing standards. They must supply updated information to OptumRx at least every 3 years.

Optumrx has a consumer rating of 1.11 stars from 374 reviews indicating that most customers are generally dissatisfied with their purchases. Consumers complaining about Optumrx most frequently mention customer service, local pharmacy and mail order problems. Optumrx ranks 318th among Pharmacy sites.

Tier 3. Preferred brand. These are brand name drugs that don't have a generic equivalent. They're the lowest-cost brand name drugs on the drug list. For most plans, you'll pay around $38 to $42 for drugs in this tier.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232