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People Experience
  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. Vanderbilt partners with Capital Rx to provide our pharmacy coverage.

 

Overview

The Vanderbilt Health Plan includes a prescription drug benefit managed by Capital Rx. 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 Capital Rx before the prescription can be filled.

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


Formulary

The formulary is the list of drugs covered under the Vanderbilt Health Plan. Capital Rx updates the formulary each quarter, so medications could be added or removed throughout the year. You can access the current formulary by selecting Lookup Formulary in the menu on www.capitalrx.com .

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

In-Network Pharmacies

The Vanderbilt Health Plan encourages faculty and staff to use in-network pharmacies, where you will get the best price for your prescriptions. The Capital Rx network includes major retailers such as Walgreens, Walmart, CVS, Sam’s Club, Costco, Publix and Kroger. For a complete list of in-network pharmacies in your area, visit www.capitalrx.com.

Mail Order Service for Long-Term Medication

Taking a 90-day maintenance medication? Consider having your medication delivered to your home by using a convenient mail order service through either  Vanderbilt Mail Order Pharmacy or Optum Rx.

With the Vanderbilt Mail Order Pharmacy, you can have a 90-day supply of your medication mailed to your home or you can pick it 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.

Capital Rx has recently partnered with Optum Rx to fill your long-term medication. To start using this convenient service, you will need to create a profile with Optum Rx. Please log on to capitalrx.com, open the menu and select Home Delivery. Follow the prompts to create an account. 

Specialty Drugs

Specialty drugs typically treat very serious diseases. They include biotechnologically produced or genetically engineered drugs that require special storage and handling. Coverage of specialty drugs is available only when filled through one of the Vanderbilt pharmacies. 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 your 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. Use the Find Best Price feature on the Capital Rx website or mobile app.
      This tool allows you to check the price of your medication at in-network pharmacies in your area so you know you’re getting the best deal.
    4. Have a conversation with your doctor.
      Let them 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?
    5. 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

If you were unable to use your insurance to fill a prescription and paid out-of-pocket, you may file a claim directly with Capital Rx for processing under your prescription benefit and request reimbursement.

Visit the Capital Rx website and open the side menu in the top right corner of your screen. Under Forms and Documents, you’ll find a claim form under Direct Member Reimbursement. Completed forms along with your original receipt from the pharmacy can be mailed to:

Capital Rx, Inc.
Attn: Claims Department
9450 SW Gemini Dr., #87234
Beaverton, OR 97008

Frequently Asked Questions

Q: What is a prior authorization?
A: A prior authorization (PA) is a feature of your prescription benefit plan that requires you and your doctor to obtain approval before the prescribed medication can be dispensed by your pharmacy. This requirement exists to prevent inappropriate prescribing of certain medications and to ensure the lowest cost alternative is used, barring medical necessity.

If you are required to submit a PA, please complete the Prior Authorization Form and fax it along with any required documentation to 833.434.0563, or mail it to:
Capital Rx

Attn: Prior Authorization
9450 SW Gemeni Dr., #87234
Beaverton, OR 97008

Q: How long does a prior authorization review take?
A: Most prior authorizations reviews are completed within two business days provided that a complete form is submitted along with all required documentation.

Q: What should I do if I’m traveling or on vacation and need immediate medication?
A: If you need medication for an extended period of time while you travel, please call Capital Rx at 833.599.0942 to speak with a customer service representative.

Q: How do I replace a lost ID card?
A: To request a replacement ID card, please call Capital Rx at 888.832.2779, or log in to the member portal to view and print a temporary ID card.

Contact Information