Pharmacy

Prescriptions (Optum/Rx in partnership with BlueCross)

When you enroll in a Continental Medical Plan, you will automatically be enrolled in the Prescription Drug plan through BlueCross BlueShield of South Carolina in partnership with OptumRx. Your medical card from BlueCross is also your Prescription Drug Card. Continental is committed to ensuring the highest quality and most cost-effective prescription drug plan. To achieve this goal, our plan includes:

If you elect to use a brand name drug when there is a generic equivalent, you will pay the brand copay, plus the difference in the cost between the brand name and generic drug. This rule applies even with “dispense as written” (DAW) instructions from your physician. These additional costs also do not apply to your deductible, coinsurance or out-of-pocket costs.

Limited to 3 refills of 31-day supply of maintenance medications. After the maximum 3 refills, a 90-day supply is available only through OptumRx Home Delivery or OptumRx Broad Pharmacy Network which includes national retail pharmacies like CVS and Walgreens.

The Broad Pharmacy Network is comprised of more than 67,000 pharmacies which equates to over 93 percent of available pharmacies. This network provides members convenient access to all major chains, grocery store pharmacies, mass merchants, small chains, Pharmacy Services Administration Organizations (PSAOs), and independent pharmacies throughout the Unites States. OptumRx Home Delivery and the Broad Pharmacy Network offers customers competitively negotiated discounts including a 90-day supply component.

Try cost-effective “First Choice” medications before trying (or “stepping up to”) more expensive “Second Choice” medications.

Limits the amount of some medications that are covered. The limits only affect the amount of medication your benefit plan will cover. You and your doctor make the final decision about the amount of medication that is right for you.

Typically prescribed to treat a complex clinical condition and/or require special handling, such as refrigeration and require prior authorization and/or subject to certain place of service requirements.

For certain medications to promote proper usage.

Get the most out of your plan with Optum Rx®.

Do you have questions about your plan? Continental’s Optum Rx page has helpful tools that can help you save money and get the most out of your benefits. You can find an in-network pharmacy, compare costs and learn more about your plan’s formulary. Visit welcome.OptumRx.com/Continental/landing to see what they can do for you.

For more information on your pharmacy benefits, visit www.optumrx.com/enroll/Continental or review the Summary Plan Description for details on Coverage Authorization Requirements located in the Reference Center on www.MyContiBenefits.com.

Could You Save More on Your Prescriptions?

Get a personalized analysis with Rx Spending and Savings Insights

Many people rely on prescription medications to manage health conditions and live their best lives. But these medications can be costly, especially if you’re not taking advantage of all the potential discounts.
Want to keep close track of your prescription drug spending — and save some money while you’re at it? Check out Rx Spending and Savings Insights, a web-based tool you can access through My Health Toolkit®.

Rx Spending and Savings Insights offers a snapshot of your prescription drug spending based on your claims history. You can:

  • See how much you’ve paid out of pocket for certain recurring prescriptions.
  • See what your benefits plan has paid.
  • Learn about possible cost savings, such as generic drug alternatives or mail-order delivery.
  • View estimates of how much money you could save.

It only takes a few minutes to keep an eye on your prescription drug spending and be a savvy health care consumer!

OptumRx is an independent company that provides pharmacy benefits management services on behalf of BlueCross BlueShield of South Carolina.