PRESCRIPTION DRUG CARD - UHPS ®

Benefits are available for Outpatient Prescription Drugs on our prescription Drug List (PDL) when dispensed by a United Healthcare Network Pharmacy. Benefits are subject to supply limits (up to 31 days) and copayments that vary depending on which Tier of the PDL the outpatient drug is listed. There are a few prescription drugs that require your Physician to notify us to verify their use is covered within your benefits.

You are responsible for paying applicable copayments. Your copayments is determined by the tier to which the Prescription Drug is assigned on the PDL. Tier status may change periodically and without prior notice to you. Please access www.uhcsr.com or call 1-877-417-7345 or the customer service number on your card for the most up-to-date status.

$15 per prescription order refill for a Tier 1 Prescription Drug
$25 per prescription order refill for a Tier 2 Prescription Drug

Your maximum allowed benefit is $500

Please present your ID card to the network pharmacy when the prescription is filled. If you do not use a network pharmacy , you will be rsponsible for paying the full cost of the prescription.

If you do not present the card you will need to pay the prescription and then submit a reimbursement form for prescriptions filled at a network pharmacy along with the paid reciept in order to be reimbursed, To obtain reimbursement forms, or for information about mail-order prescriptions or network pharmacies, please visit www.uhcsr.com or call 1-877-417-7345 or the customer service number on your card for the most up-to-date status.