Prescription drug benefits are available for our members through the Superior Officers Council Health and Welfare Fund Prescription Plan administered by OptumRx. Certain specialty drugs not covered by the Fund’s Prescription Drug Plan may be available through the City Health Benefits Plan, commonly referred to as PICA. Medications prescribed as a result of a Line-of-Duty Injury (LODI) are covered in FULL through the New York City Police Department’s Line-of-Duty Prescription Drug Program. Information regarding the NYPD LODI Prescription Drug Program is included in this section.


Prior authorization (PA) review is needed to determine coverage for products involved in the Step Therapy Program. 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. For further information, your physician can contact the OptumRx Prior Authorizations Department at 1-800-711.4555. option 2.

If the drug that is needed requires prior authorization and you are unable to wait for prior authorization to be reviewed 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

In the case of prior authorization denial – 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. 

Rx In-Step Programs (Step Therapy Programs) employ “smart edits” requiring patients to use clinically effective products that have the most economic value within specific therapeutic categories. These programs are created for categories where there are several products that deliver similar safe and effective results but have significant differences in cost. The categories covered, and Step Therapy Programs required, are available by contacting OptumRx at (800) 356-3477 or the SOC Fund Office.

It’s easy to find a participating pharmacy in your local area. With more than 60,000 pharmacies in the OptumRx network, you’re sure to find one that’s close to home or work.
If you need assistance locating the pharmacy closest to you, call OptumRx Customer Service at 800-356-3477 or visit

Every covered member is issued a prescription drug card that will certify the member’s and the dependent’s eligibility for the OptumRx's Drug Plan. All you must do is present your card to the pharmacy and your claim will be processed electronically. If you lose or misplace your prescription benefit card, you can call the SOC Fund Office at (212) 964-7500, option 1, during regular business hours. You will receive replacement cards within 7-10 business days.

To save money on your prescriptions, try requesting generic products. Not all brand name products have equivalent generic alternatives, but it is a good idea to ask your doctor if your brand name medication can be substituted with a similar generic product before you request it from the pharmacist.

Certain drugs combine two or more existing individual drugs into a single pill. This process may increase the cost factor of the pill by a factor of 10. The SOC does not cover combination drugs such as Caduet, Simcor, or Advicor. The SOC does cover the individual medications contained in these drug combinations. Speak to your physician about the possibility of prescribing the individual medications.

The Superior Officers Council Prescription Plan offers a program that allows you to order prescription products through the mail. Using OptumRx Mail Order Pharmacy is an easy way to have your prescriptions delivered right to your home. People on maintenance medications (medications that are taken on an ongoing basis) will especially enjoy the convenience of not having to go to the pharmacy as often.
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.
For an enrollment application, call OptumRx Customer Service at 800-356-3477 or visit their web site at or call the SOC Fund Office at (212) 964.7500, option 1.
Prescriptions filled through the mail order facility should be received 10-14 days from the date the prescriptions are mailed.

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.

On some prescriptions, you will find quantity limitations. Quantity limits are based upon FDA guidelines published clinical recommendations, such as the Journal of the American Medical Association (JAMA), as well as manufacturer packaging and labeling instructions. Limits are intended to encourage appropriate dosing. *Exceptions are generally limited to chronic conditions that necessitate a quantity greater than “normal.” These limits are not intended restrict access to quantities of medications where limits would not be considered functional or appropriate.
*NOTE: If you have a chronic condition that may necessitate a quantity greater than “normal,” you can contact the SOC Fund Office for further assistance.