INDIVIDUAL & FAMILY PLANS
Pharmacy and Prescription Drugs
Pharmacy Customer Service is available at (855) 869-4769, 24 hours/7days a week/365 days a year. We can answer questions related to a medication covered on UUHPs Preferred Drug List (PDL), finding an in-network pharmacy, prior authorization, member web portal, mail order program, and providing information on processed pharmacy claims. Pharmacy Customer Service is also available to work directly with your providers on prior authorizations and your pharmacies on any questions or issues related to processing a claim.
Pharmacy Benefits
2024 Preferred Drug List (PDL)
Individual plans use the U of U Health Plans Preferred Drug List (PDL) – Please note that the PDL is subject to change.
2023 Preferred Drug List (PDL)
Individual plans use the U of U Health Plans Preferred Drug List (PDL) – Please note that the PDL is subject to change.
GENERAL PHARMACY INFORMATION
| Contact & Processing Information | Pharmacy Customer Service:855-869-4769 Pharmacy Processing Information: BIN: 610830 PCN:REALRX |
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| Find a Pharmacy | Find a In-Network Pharmacy U of U Health Pharmacies |
| 90-Day Supply | 90 day supply can be obtained through University of Utah Health pharmacies and Birdi Mail Order pharmacy for Tier 0, 1, 2, and 3 medications. Enroll in the Mail Order Program (through Birdi Mail Order) First, enroll in the Mail Order Program (through Birdi Mail Order) Next, call to get started: 877-668-4987 - or - Use the Birdi Member Portal: Birdi Portal Login Then, download the mail medication order form: Birdi Mail Order Form |
| Member Pharmacy Portal | Access your pharmacy claim history, search for pharmacies, or view the formulary To get a login, Pharmacy Customer Service: 855-869-4769 Visit RealRx and Login |
| Pharmacy Direct Member Reimbursement | If you have paid out of pocket for a prescription and are looking to be reimbursed through the plan, please contact Pharmacy Customer Service before submitting a DMR Form. Pharmacy Customer Service will work with you to contact your pharmacy to assist them in processing claims electronically. This is the quickest process as the pharmacy can refund you onsite. If the pharmacy is unwilling to submit electronically, then Pharmacy Customer Service will assist you in filing a DMR. (Please note: the DMR process can take up to 30 days to complete and does not include any network discounts that the pharmacy would have written off per contract.) Please contact Pharmacy Customer Service for questions or assistance in submitting a reimbursement request for a prescription. |
| Brand - Generic Charge | Brand-Generic Charge is applied if you receive a Brand name drug, regardless of reason or medical necessity, or if your provider prescribes a Brand name drug when a generic is available. A Brand-Generic Charge is the difference in cost from the Generic to the Brand name drug. This charge is added to the regular cost sharing outlined in your benefits summary. The Brand-Generic charge does not apply towards your Out-of-Pocket Max. |
| Medications with Special Requirements | Some medications have special requirements (Quantity Limits, Prior Authorization, and Step Therapy) that must be met before U of U Health Plans will cover them. This process must be completed by your doctor before you can fill a prescription.
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| Prior-Authorization | To request submit a Prior-Authorization or Exception Request, the provider can either print and fax the forms for review or submit the request online Pharmacy Prior Authorization and Exception Request form (print and fax) Submit Prior Authorization or Exception Request online |