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    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 U of U Health Plans' 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.

    2021 Pharmacy Benefits

    2021 Pharmacy Benefits FAQs

    2021 Preferred Drug List (PDL)

    Group 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
    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 NoviXus Mail Order pharmacy for Tier 0, 1, 2, and 3 medications. Enroll in the Mail Order Program (through NoviXus Mail Order)
    First, download the form: NoviXus Mail Order Form
    Next, call to get started: 877-668-4987 - or -
    Use the NoviXus Member Portal: NoviXus Portal Login
    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.
    • Prior Authorization is needed for certain drugs listed on the preferred drug listed. In addition, all Specialty Medications (Tier 4) require prior authorization.
    • Step Therapy is a type of prior authorization for medications that require your provider to first prescribe and you to try alternative options that are generally more cost effective and that have proven effective for your condition before you can move up a “step” to a more expensive medication.
    • Quantity Limits is a set maximum of a quantity a medication that a person may have covered under the plan within a certain period of time for safety and cost reasons.
    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

    Questions about Plans?