The Prescription Formulary

OptumRx maintains a formulary, or list of covered medications, organized by a three-tier copayment structure. Some medications may have:

• Quantity limits
• Step therapy requirements
• Prior authorization requirements

New medications are regularly reviewed by the OptumRx Pharmacy and Therapeutics Committee made up of pharmacists, physicians, and nurses, to ensure the formulary remains safe, effective and aligned with current clinical standards.

January 1, 2026 OPTUMRX FORMULARY

You can log in to the OptumRx website to view the most up-to-date formulary, including any changes or additions.

Some medications are excluded from coverage because preferred alternatives are available.

If you are prescribed an excluded medication:

• Talk with your doctor about switching to a covered alternative
• If medically necessary, your doctor can request an exception

To request an exception, your provider must submit a letter of medical necessity to OptumRx. To begin the process, your physician can contact the OptumRx Prior Authorization Department at 1-866-441-2422.

For questions or to appeal a decision, contact OptumRx Customer Service at the same number.

OPTUMRX PRIOR AUTHORIZATION

Brown University partners with PillarRx to support employees and dependents who use specialty medications for complex or chronic conditions.

If your medication qualifies for copay assistance, you’ll receive information directly from PillarRx. You can also call 636-614-3126 to check eligibility.

Calibrate is a virtual program available through OptumRx that supports weight management and metabolic health. The program combines:

• GLP-1 weight loss medications such as Zepbound® or Wegovy®
• One-on-one coaching
• Sustainable lifestyle changes 

Calibrate Overview