OptumRx acts as the Pharmacy Benefit Manager for a majority of CalPERS health plans. OptumRx replaced CVS/Caremark on January 1, 2017 in administering prescription drug benefits for about 632,000 CalPERS members and their families.

The following health plans feature OptumRx:

  • PERS Gold & PERS Platinum PPO plans (Basic and Medicare Supplement)
  • Anthem Blue Cross EPO, Traditional & Select HMOs
  • Anthem Blue Cross Monterey & Del Norte EPOs
  • Health Net SmartCare & Salud y Más
  • Sharp Health Plan Performance Plus
  • UnitedHealthcare SignatureValue Alliance & Signature Value Harmony
  • Western Health Advantage HMO

Blue Shield of California, Kaiser Permanente, and UnitedHealthcare Group Medicare Advantage PPO health plans were not affected.

Pharmacy Benefits

Members can take advantage of OptumRx benefits that include:

  • Home delivery and Preferred90 retail pharmacy program; receive up to a three-month supply on maintenance medication for two copayments.
  • Access to large national chain and local pharmacies.
  • Up to a three-month supply on maintenance medication for three copayments at a participating pharmacy other than home delivery or a Preferred90 retail pharmacy.
  • Online account management.

Pharmacy Copayments

Your health plan's pharmacy copayments for will remain the same, however, some drug coverage and cost share may be different, which could impact your out-of-pocket cost.

For more information about OptumRx, visit the OptumRx website.