OptumRx is the university’s pharmacy benefit provider. Employees are automatically enrolled in this prescription drug coverage if they enroll in a Brown health plan. Subscriber ID cards are sent to employees’ home addresses and should be presented for all prescription drug purchases.
Understanding which medications are covered: The Prescription Formulary
OptumRx uses a formulary, which is a list of all covered drugs. The formulary as of January 1, 2021 can be seen below, as well as a list of exclusions. There is also a summary of the three-tier copayment structure. Some drugs have quantity limits or other requirements before they can be dispensed under the formulary. Also, as new drugs come to market, they are reviewed by OptumRx’s Pharmacy and Therapeutics Committee, which is made up of pharmacists, physicians and nurses to help ensure that the formulary is medically sound and that it supports patient health. Please log in to www.OptumRx.com to see the latest formulary reflecting any additions.
For members using BriovaRx: BriovaRx is now Optum Specialty Pharmacy.
If your doctor prescribes a medication that is excluded from the formulary:
The formulary excludes certain medications that have one or more preferred alternatives. For excluded medications, first consult with your doctor about switching to the alternative medication(s). If there is a medical necessity that requires you to take the excluded medication, ask your doctor to submit a letter of medical necessity explaining why you must take the excluded medication. Please have your physician phone the OptumRx PA Department at 1-866-441-2422 to initiate this process and provide medical necessity documentation. Contact OptumRx Customer Service at the dedicated Brown University toll-free member phone number 1-866-441-2422 for more information on submitting an appeal.
Specialty Medication Co-Pay Assistance
Brown has partnered with PillarRx to assist employees and family members who take specialty medications for complex or chronic medical conditions. If you or your covered spouse or dependent take a specialty medication through OptumRx for which the Copay Assistance program is available, you will receive information directly from PillarRx. You may contact PillarRx at 636-614-3126 to determine if your specialty medication is eligible for financial support.