FAQ Page

Below you'll find answers to our most popular questions. If you you don't see your question here or need other help, please call the number for your plan shown on our Contact Us page.
[fa icon="plus-square"] Who do I contact with questions regarding my pharmacy plan?
If you have questions regarding your pharmacy plan or any changes occurring, please call your member services team or care coordinators at the number located on your pharmacy ID card or under the Contact Us tab.
[fa icon="plus-square"] Who is Hospitality Rx and why did my pharmacy benefits change from OptumRx/Catamaran to Hospitality Rx?

Hospitality Rx is the new Pharmacy Benefit Manager for UNITE HERE HEALTH.


UNITE HERE HEALTH created Hospitality Rx to better serve its members and improve their overall prescription benefit coverage and experience.

[fa icon="plus-square"] What do I do with my OptumRx pharmacy card?
Since your pharmacy benefits are now through Hospitality Rx, you can disregard your OptumRx pharmacy card and begin to use your Hospitality Rx pharmacy ID card. If you did not receive your Hospitality Rx pharmacy ID card, please call your member services or care coordinators team by the number on the Contact Us page.
[fa icon="plus-square"] Can I still use my current retail pharmacy?
Yes, your current retail pharmacy network has not changed unless there’s been a benefit change notice sent to you. Please visit your plan page (under Members at the top) to locate the most convenient network pharmacy or continue to use your current pharmacy. You can also call your member services team or care coordinators at the number located on the back of your card or on our Contact Us page.
[fa icon="plus-square"] What medications are covered under my plan?

Click here to use our pharmacy lookup tool.

  1. Select your plan.
  2. Enter your drug’s name or select its class.
  3. You’ll get a list of brand name and generic drugs covered by your plan. The lookup will also tell you if any drugs are excluded.
  4. Work with your doctor to decide which drug will work best for you. Remember, generics will save you money.
[fa icon="plus-square"] Why isn’t my medication covered?
There are several factors when determining why a medication is not covered:
  • You do not have a valid prescription or a prescription is not needed for this medication.
  • Your prescription may be part of our clinical program and a review is required before you may receive the medication.
  • It is not on your Formulary drug list.
  • It is not a covered benefit and excluded.
  • Medical devices are not covered under your pharmacy benefit; however they may be covered under your medical benefit.
  • The medication is new to the market or experimental.
  • The FDA, or Food and Drug Administration has deemed the medication not effective and/or safe.
  • Your medication is dispensed in your doctor’s office; which may be covered under your medical benefit.
  • You no longer have coverage with UNITE HERE HEALTH.

If your medication is not covered by your plan, that does not mean you are unable to obtain the drug from your pharmacy; however it will not be covered and you will be responsible for the full cost when presenting your prescription.


For further information or to learn more about your drug coverage, please contact your member services team or care coordinators at the number on the back of your card, or visit our Contact Us page.

[fa icon="plus-square"] How do I find out if I can take an alternative drug in place of one that is not covered?

Click here to use our pharmacy lookup tool.

  1. Select your plan.
  2. Enter the name of the drug that isn’t covered or select its class.
  3. The drug lookup may give you a list of alternative drugs, or it may only give you a phone number to call.
  4. After you call the phone number, work with your doctor to decide which drug will work best for you.
[fa icon="plus-square"] How much is the copay for my drug?

Click here to use our pharmacy lookup tool.

  1. Select your plan.
  2. Enter your drug’s name or select its class.
  3. You’ll get a list of brand name and generic drugs covered by your plan. It will also tell you the copay and let you know if any drugs are excluded.
  4. Work with your doctor to decide which drug will work best for you. Remember, generics will save you money.
[fa icon="plus-square"] What is a specialty drug?
Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis. Specialty drugs often require special handling (like refrigeration during shipping) and administration (such as injection or infusion).
[fa icon="plus-square"] I have a specialty medication; can I still use the same pharmacy?

Specialty drugs may be received ONLY through Diplomat Specialty for most plans; one exception is for Atlantic City participants who can also use their on-site pharmacy.


If you have not received a call from Diplomat Specialty to enroll, please call them at (844) 813-3860 to sign up.


If you had a specialty medication previously, Hospitality Rx has worked with your previous specialty pharmacy to transfer this medication over to Diplomat Specialty; there should be no interruption in your therapy.


If you have any questions please call your member services team or care coordinators at the number listed on your card or under Contact Us.

[fa icon="plus-square"] What is prior authorization or step therapy and why can’t I get my medication?

These are clinical programs that make sure you get the right medication based on the FDA’s standards for safety and effectiveness. They also encourage the use of lower-cost yet high quality medications. These programs keep your pharmacy benefit affordable.

 

To find out if your medication requires step therapy or prior authorization, click here to use our pharmacy lookup tool.

  1. Select your plan.
  2. Enter your drug’s name or select its class.
  3. You’ll get a list of brand name and generic drugs covered by your plan. The lookup will also tell you which medications require step therapy or prior authorization.
  4. If you see a medication on the list that does not require step therapy or prior authorization, work with your doctor to see if you can use that medication instead. Remember, generics will save you money.
[fa icon="plus-square"] What do I do when I can’t get my medication because of prior authorization/step therapy?

If you had a prior authorization previously on your medication, Hospitality Rx has worked with Catamaran/OptumRx to transfer this prior authorization over; there should not be any interruption in your medication therapy.


If you are using a new medication that requires prior authorization, please have your doctor call the Pharmacy Prior Authorization number on your card for assistance. A member of Hospitality Rx’s Prior Authorization and Clinical team will review this request.


If you have questions regarding your medication or the Prior Authorization process, please call your member services team or care coordinators at the number located on your card or on our  Contact Us page to speak to a representative.

[fa icon="plus-square"] Will my mail order pharmacy change?

Yes, your mail order pharmacy will change on 4/1/2016 from Catamaran Home Delivery to WelldyneRx Prescription Delivery.
Hospitality Rx is partnering with WelldyneRx to provide mail order pharmacy services.


You can enroll by phone at (844) 813-3860 or online at http://www.mywdrx.com to create a login and verify allergies, medical conditions, shipping address, payment information, etc. You must enroll BEFORE in order for WelldyneRx to send you medications.


Once enrolled, you or your doctor can submit new prescriptions one of three ways:

  • Your doctor can send your prescription electronically to WelldyneRx Prescription Delivery.
  • Your doctor can fax your prescription to: (888) 830-3608 or (877) 221-1259.
  • You can mail your prescription to: WelldyneRx, P.O. Box 90369, Lakeland, FL 33804
[fa icon="plus-square"] Will my mail order prescriptions transfer from OptumRx to Hospitality Rx?
With the exception of: expired prescriptions, controlled substances, prescriptions with no refills remaining and prescriptions that were on file but never filled, all others have been transferred from OptumRx to Hospitality Rx; you will not experience any interruption in your medication therapy.
[fa icon="plus-square"] Where can I find forms relating to Hospitality Rx?
All forms can be located on your plan page (under Members at the top). All instructions on how to submit the various forms are located on the form. If you have further questions, please reach out to your member services team or care coordinators at the number on the back of your card or view our Contact Us page.
[fa icon="plus-square"] If I am eligible, how do I get reimbursed for a prescription drug claim?

In order to receive your reimbursement, you must first complete the Reimbursement Claim Form; this can be found on your plan page (under Members at the top).

Complete all of the information on the claim form, or as much as possible. Remember, you must complete a separate form for each family member. Please make sure to include all the below information:

  • Original receipt with prescription details from your pharmacy.
  • If necessary, contact the pharmacist to provide the detailed drug information requested on the reimbursement claim form.
  • Complete name, address and telephone number of the pharmacy.

Mail the completed form and original receipts directly to WelldyneRx. The address to mail to will be located on the form. You will receive a response within 30 days.

Should you or your pharmacist have any questions regarding the completion of this form or process, please call WelldyneRx’s toll-free number at (888) 479-2000. This number is available 24 hours a day, 7 days a week.

[fa icon="plus-square"] Can I see the same physician?
Please contact your member services team or care coordinators at the number on the back of your medical ID card or view our Contact Us page.