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Human Resources
Division of Administration
  2. Benefits
  3. Prescription Drug Benefit

Prescription Drug Benefit

Prescription drug coverage is included with both health plan options, but costs apply differently depending on which plan you choose. CapitalRx is our pharmacy vendor.

 

Overview

The Vanderbilt Health Plan includes a prescription drug benefit managed by CapitalRx. The prescription drug benefit is a multi-level formulary (i.e., list of covered drugs) with a recommended generic program.

Not all prescription drugs are covered by the Vanderbilt Health Plan. Some prescription drugs require prior authorization from CapitalRx before the prescription can be filled.

For questions regarding your prescription drug program, contact CapitalRx at www.capitalrx.com or call 1-833-599-0942


Formulary

The formulary is the list of drugs covered under the Vanderbilt Health Care Plan. You can see the list on the Capital Rx member website:

  1. Go to www.capitalrx.com
  2. Click on Member Login
    • If you have already registered, enter your User ID and Password. Then answer the security question.
    • If you haven't registered yet, click on the link for Click here for new registrations. You will need your social security number or Member ID located on your Capital Rx card.
  3. Once you have logged in with your user name and password, you will see the homepage. Select the menu
  4. Click on Lookup Formulary

If you need help, contact Capital Rx Customer Care at 1-833-599-0942

Vanderbilt and In-Network Pharmacies

The Vanderbilt Health Plan encourages faculty and staff to use in-network pharmacies, where you will get the best price for all other prescriptions. Click here for a list of major retailers in the Capital Rx network.

Mail Order Service

Mail order service is available through the Vanderbilt Mail Order Pharmacy and is an easy way for you to purchase a 90-day supply of your long-term or maintenance medications. The prescriptions can be mailed to your home or picked up at the Vanderbilt Pharmacy of your choice.

For more information on how to start the mail order service, call the Vanderbilt Pharmacy mail order service at 615.875.0078 or visit the Vanderbilt Ambulatory Pharmacy Services webpage.

Getting Started with Optum

Please reach out to your prescriber and update your mail order pharmacy provider as Optum. Before
prescriptions can be filled through Optum, a profile needs to be created. Please log on to capitalrx.com, open the menu and select Home Delivery. Follow the prompts to create an account. 

Specialty Drugs

Coverage of specialty drugs is available only when filled through one of the Vanderbilt pharmacies. Specialty drugs typically treat very serious diseases. They include biotechnologically produced or genetically engineered drugs that require special storage and handling. Please contact Capital Rx for more information about specialty drugs or see the Vanderbilt Specialty Pharmacy website.

Mobile App

 With Capital Rx's mobile app you can:

  • Search for the lowest cost drug at surrounding pharmacies
  • View yoru claims history
  • Download a digital pharmacy card
  • View which drugs are covered under you plan
  • Track how much money you have paid toward your out-of-pocket expenses. 

The mobile app features easy registration, simple navigation, and an innovative, user-friendly design to help you navigate your prescription benefits. Plus, you’ll gain access to all of the helpful information you need to make informed decisions about your prescriptions and health.

Money-Saving Tips

  1. Ask for a generic drug. Generic drugs are less expensive because generic manufacturers don’t have the investment costs of the developer of a new drug. These drugs use the same active ingredients as a brand-name drug, and are shown to work the same way in the body.
  2. Use a pharmacy in the Capital Rx network. The Capital Rx website has listings and maps of participating pharmacies in your area, including 24-hour pharmacies.
  3. Have a conversation with your doctor. Let him or her know that cost is a concern for you. Ask these questions:
    • Are there medications available that work the same but cost less?
    • Are there generic drugs that will work the same as my brand-name drugs?
    • Are free samples available?
    • Is there an older version of the drug that would be just as effective but is less expensive?
    • Is pill splitting an option?
  4. Have a conversation with your pharmacist and ask these questions:
    • Ask if any new generic drugs have become available.
    • Ask if any of your prescription drugs have become available over-the-counter.
    • Ask if buying in larger quantities will save you money, such as buying a 90-day supply instead of a 30-day supply.

Drug Manufacturer's Coupons
The Vanderbilt Health Plan does not allow pharmacies to accept drug coupons for prescriptions because drug manufacturers promote their drugs with these coupons, which generally are more costly than a generic equivalent or a preferred drug for the health plan. While the patient’s use of a coupon will lower his/her own out-of-pocket cost, it lessens the patient’s responsibility as an active participant in the Vanderbilt Health Plan. Vanderbilt University pays the remaining cost whether or not coupons are used, yet pharmaceutical companies are trying to increase their utilization with these coupons, which drives up the cost to the health plan.

How to File a Claim

  1. Open the side menu in the top right corner of your phone screen.
  2. Select Forms and Documents.
  3. Here you will find information regarding mail order delivery, specialty pharmacy enrollment
    and will be able to download related forms where applicable.

Contact Information