Private SOC Content
FREQUENTLY ASKED QUESTIONS
Q: What will I need to do for mail order prescriptions?
A: In order to be eligible to enroll in OptumRx Mail Order Pharmacy, you must fill your prescription two times at the retail level. Once you have enrolled in OptumRx Mail Order Pharmacy, you will need a new prescription from your physician for up to a 90-day supply and mail it, along with the completed enrollment forms and correct copayment, to the mail order facility.
Q: How long will it take for my medication to reach me through mail order?
A: Prescriptions filled through the mail order facility should be received 10-14 days from the date the prescriptions are mailed.
Q: How do I obtain a prior authorization?
A: The OptumRx Prior Authorization Program can be initiated by either the pharmacist or the member contacting OptumRx Customer Service Center. OptumRx representatives will work with your doctor’s office and pharmacy to obtain the information required.
Q: What if the drug that I need requires prior authorization and I cannot wait for the prior authorization to be reviewed?
A: Ask your physician if a drug sample is available or your pharmacy may provide you with a short-term supply. You will be responsible for the full copayment at this time. If the prior authorization is approved, your pharmacist can dispense the remainder of the prescription.
Q: What if my prior authorization is denied?
A: The Superior Officers Council Prescription Plan design includes medications that effectively treat most medical conditions. Most likely, there is an alternative product that may be prescribed by your doctor that will not require prior authorization. If no other options are available and the prescribed treatment is medically necessary, you have the option of appealing the denial.
Q: How come I used to be able to receive my medication but am not able to now?
A: From time to time, there may be changes to the Superior Officers Council Prescription Plan design. If you have trouble getting your prescription filled, a representative at the OptumRx Customer Service center may be able to offer advice
Q. Are there any restrictions or limitations to the line-of-Duty prescription program?
A. Yes, the Line-of-Duty Prescription Program is a mandatory generic drug program. If a generic drug is available, then the brand name drug is not covered. An initial five-day supply is
limited for high cost medications. Other clinical and cost containment safeguards are
administered (quantity limits, step therapy, prior authorization, refill too soon, drug to
drug interactions, etc.).
Q. Who can I call if I have questions about the line-of-injury prescription program?
A. Uniformed Members of the Service who require help or guidance with any aspect of the
Line-of-Duty Prescription Drug Program can contact the Emblem Health 24-hour help
desk at 800 477-8255, the Medical Division’s Line-of-Duty Prescription Drug Unit, Monday
through Friday, from 7 a.m. to 6 p.m., at 718.760.3059/3194 or the Medical Division’s
Sick Desk Supervisor (24 hours per day) at 718.760.7606.
Q. Where can I get a line-of-Duty prescription program Card?
A. Blank cards are not individual specific and are available through the Medical Division via fax
by contacting Emblem Health 24-hour help desk at 800.447-8255 or by going to www.
nypd2.org/fh/. The user name is “finesthealth” and the password is “stayhealthy.” Cards may be
printed from your computer and/or photocopied.
Q: What will I need to do for mail order prescriptions?
A: In order to be eligible to enroll in OptumRx Mail Order Pharmacy, you must fill your prescription two times at the retail level. Once you have enrolled in OptumRx Mail Order Pharmacy, you will need a new prescription from your physician for up to a 90-day supply and mail it, along with the completed enrollment forms and correct copayment, to the mail order facility.
Q: How long will it take for my medication to reach me through mail order?
A: Prescriptions filled through the mail order facility should be received 10-14 days from the date the prescriptions are mailed.
Q: How do I obtain a prior authorization?
A: The OptumRx Prior Authorization Program can be initiated by either the pharmacist or the member contacting OptumRx Customer Service Center. OptumRx representatives will work with your doctor’s office and pharmacy to obtain the information required.
Q: What if the drug that I need requires prior authorization and I cannot wait for the prior authorization to be reviewed?
A: Ask your physician if a drug sample is available or your pharmacy may provide you with a short-term supply. You will be responsible for the full copayment at this time. If the prior authorization is approved, your pharmacist can dispense the remainder of the prescription.
Q: What if my prior authorization is denied?
A: The Superior Officers Council Prescription Plan design includes medications that effectively treat most medical conditions. Most likely, there is an alternative product that may be prescribed by your doctor that will not require prior authorization. If no other options are available and the prescribed treatment is medically necessary, you have the option of appealing the denial.
Q: Is my spouse eligible for the Medicare Rebate Program?
A: Both the member and their spouse are eligible for the Medicare Rebate once they become Medicare eligible.
Q: I didn’t know my spouse was eligible and I didn’t enroll them in the rebate plan, what
can I do?
A: If you failed to enroll your spouse when they became Medicare eligible you can request
for retroactive reimbursement up to but not more than three (3) years. You will be required
to provide the Health Benefits Program listed above with a written request for enrollment
and a copy of your spouses Medicare Card.
Q: When can i expect to receive my Medicare rebate check?
A: Standard rebate checks are issued annually during April and higher premium (IRMAA)
reimbursement checks are usually issued in October.
Q: Will my Medicare eligible spouse get a separate rebate check?
A: If you and your spouse are both covered by Medicare, you will receive one Rebate check,
including rebate payment for yourself and your spouse, with the check issued in the name
of the retiree.
You can obtain further information regarding the Medicare Rebate Program and download forms in regards to IRMAA by visiting the NYC Office of Labor Relations website at
www.nyc.gov/olr and click on the “Health Benefits Program” icon.