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2024 Premium Standard Formulary

WEBsafety, cost, and effectiveness. Medications are listed by categories or classes and are placed into cost levels known as tiers. It includes both brand and generic prescription …

Actived: 7 days ago

URL: https://content-hub.optumrx.com/media/2023-10/Premium-Formulary.pdf

Optum Rx Preventive care medications

WEBA prescription is required to get these medications and supplements at no cost - even though most are available over-the-counter (OTC). Medication/Supplement. Reason. …

Category: Supplements Go Health

2024 Preventive medications and your plan

WEBcimetidine 200 cimetidine acid reducer cimetidine oral. CYTOTEC. dexlansoprazole dual action complete oral tablet chewable 10-800-165 mg. DUO FUSION esomeprazole …

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2024 Premium Value Formulary Effective Jan. 1, 2024

WEBbutalbital- acetaminophen oral tablet 50-325 mg. 2. butalbital-apap-caff-cod. 1. butalbital-apap-caffeine oral capsule 50-300-40 mg. 1. For more information regarding the tiers …

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OptumRx 2023 Preventive medications and your plan

WEBThe drugs on your plan’s preventive medications list do not have a deductible. This means you’ll pay your copayment/ coinsurance or nothing at all, depending on your …

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Pharmacy benefit summary

WEBPharmacists and patient care coordinators are available 24/7 to take care of everything, including: • Transferring your prescription. • Helping you find affordable ways to get your …

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Pharmacy Plan Benefits Comparison

WEBPharmacy Plan Benefits Comparison. Standard Deductible: Assumes participant and covered spouse (if applicable) met Health Check incentive requirement in 2023. If not …

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IMPORTANT PLAN INFORMATION …

WEBVeterans Health AdministrationVetera n s H ea lth Ad m in istra tion Office of Community Care (VHA OCC)Office of C om m u n ity C a re (V H A O C C )

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Keep your card in a safe place

WEBThis document and others, if attached, contain information from Optum Rx which is proprietary, confidential and/or may contain protected health information (PHI).

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Pharmacy benefit summary

WEBPharmacists and patient care coordinators are available 24/7 to take care of everything, including: • Transferring your prescription. • Helping you find affordable ways to get your …

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PRESCRIPTION REIMBURSEMENT REQUEST FORM

WEBThe company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. Free services are provided to help you …

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BENEFICIARY FAQ'S

WEBBeneficiaries who have an active health insurance plan that includes a pharmacy benefit are eligible to use the retail benefit administered by OptumRx. If you believe your Other …

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Prior Authorization Request Form (Page 1 of 2)

WEBThis document and others if attached contain information that is privileged, confidential and/or may contain protected health information (PHI).

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GE HealthCare Specialty Drug Center of Excellence program

WEBTitle: GE-HealthCare-COE-FAQ Author: [email protected]: 952-934-8100 Created Date: 10/24/2023 2:56:33 PM

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CREDENTIALED PHARMACIES LISTING

WEBReturn to Menu Pharmacy Name Address City State Zip Code Phone Fax TOP HRT PED NAS STR SUP PTD Advanced Infusion Solutions 623 Highland Colony Parkway Suite …

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PRESCRIPTION REIMBURSEMENT REQUEST FORM

WEB42573A-042015 104-0012 2/17 ORX5262E_19100961908-022019 Instructions for submitting form 1. Include the original pharmacy receipt for each medication (not the …

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