When you enroll in medical coverage, you and your covered family members also receive prescription drug benefits. Your out-of-pocket costs depend on your employment status and which medical plan you choose. All JHU prescription plans offer a convenient, money-saving mail-order pharmacy feature.
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Prescription Drug Benefit
JULY 1: Mail Order and Specialty Pharmacy Moving from Optum to Costco
CareFirst health plan members will experience a change in mail order and specialty pharmacy services. Beginning July 1, 2025, Capital Rx is changing from Optum Rx to Costco Pharmacy as the in-network mail order and specialty prescription provider. For more information, review the FAQs below and stay tuned for updates from Benefits & Worklife and Capital Rx.
FAQ for Mail Order and Specialty Pharmacy Change
What is changing?
Effective July 1, 2025, Capital Rx is switching from Optum Rx to Costco Pharmacy as the in-network provider of mail order and specialty prescriptions. Faculty and staff who are currently enrolled in a JHU CareFirst health plan and are using these services may need to take some actions to transfer prescriptions to the new provider.
Why is this change happening now?
We heard your feedback about Optum Rx and so did Capital Rx. Costco Pharmacy is more compatible with Capital Rx systems, so this change should improve the experience for mail order and specialty pharmacy customers.
Do I need to take action to transfer my prescriptions?
Most currently open active prescriptions with Optum Rx will be automatically transferred to Costco Pharmacy. Certain prescriptions will not transfer automatically, so be sure to read the corresponding FAQs below.
What prescriptions will not transfer automatically?
Prescriptions that fall under the following categories are not eligible for transfer with the open prescription transfer file.
- Expired prescriptions
- Prescriptions for controlled substances
- Prescriptions with zero refills remaining
- Prescriptions that are new or renewed that were not filled
- Compound prescriptions
- Prescriptions from a local retail pharmacy
You must take action to transfer these prescriptions. Late June, Capital Rx will reach out with instructions on how to create your Costco Pharmacy account, add your delivery and payment information, and transfer your prescriptions.
What should I expect before the change to Costco Pharmacy on July 1?
If you currently use Optum Rx for mail order prescriptions, then you’ll receive a letter from Capital Rx in June. Capital Rx will call you on or after June 15 to offer help with setting up your Costco Pharmacy profile, prescription transfer or prescriber outreach for a new prescription, and digital registration assistance.
Do I need a Costco membership to use Costco Pharmacy?
You do not have to be a Costco member to access their pharmacy.
If I’ve already gotten pre-authorization for a medication, do I need to do it again?
No, you will not need to obtain a new pre-authorization to switch to Costco Pharmacy. Captial Rx manages all pre-authorizations.
Can I use a Costco Warehouse Retail Pharmacy to get a 90-day supply of mail order medication at the same cost?
Yes, you’ll be able to obtain a 90-day supply of maintenance medications through any Costco Warehouse Retail Pharmacy. The copayment is the same as the mail order copayment and you do not need to be a Costco member to access the pharmacy.
Can I move to a pharmacy other than Costco Pharmacy?
Yes, there are other retail pharmacies in the Capital Rx network, however the only in-network mail order and specialty medication providers are Costco Pharmacy and Johns Hopkins Outpatient Pharmacy.
View the list of the national chain and large independent pharmacies in the Capital Rx commercial pharmacy network here. To find the nearest in-network pharmacy, log into the member portal at cap-rx.com and select nearby pharmacies. Log into Capital Rx via SSO from the Quantum Health member portal.
Available as an alternative for mail order and prescription services, Johns Hopkins Outpatient Pharmacy (JHOP) offers a full inventory of standard, specialty, and over-the-counter medications, as well as the convenience of discharge medication processing. You can fill your 90-day supply maintenance medications through one of its outpatient pharmacies or use their mail order services. Here are the JHOP Locations. To transfer your prescriptions to JHOP, call their service center at 888-264-0393.
What are the advantages of using Costco Pharmacy?
Costco Pharmacy will be the in-network manager of mail order and specialty prescriptions, so there are several key benefits including cost savings compared to full-price medications, convenience, and consistency.
Will my copayments increase with this transition?
Most members’ costs will remain the same or decrease with the transition to Costco. Some members may experience a slight increase in their prescription cost.
You can easily view the expected medication cost by logging into the member portal and click the Find Best Price button at the top of the dashboard and complete the fields as prompted. A list of local pharmacies will be provided along with the expected cost for the specified medication.
If I currently have an account with Optum Rx, will I need to create an account with Costco Pharmacy? Or will that be done for me automatically?
You will need to enroll with Costco Mail Order or Costco Specialty Pharmacy to create your account(s). To help with digital registration, some member demographic information has been provided to Costco Pharmacy to help reduce the amount of information you’ll need to provide.
Will I be able to manage my dependent child’s mail order benefit?
You’ll be able to manage medications for your dependents under the age of 18 from your Costco Pharmacy account; there is no need for children to create a separate account.
What if I need help?
Reach out to Quantum Health, your free healthcare navigator as a CareFirst plan member. They can answer questions about coverage, find a pharmacy, or find the lowest-cost options for a drug. They can also reach out to your provider to request a refill or a different formulary option. Contact Quantum Health care coordinators at 1-844-460-2801, Monday through Friday from 8:30 a.m. to 10 p.m., or access the Quantum Health member portal.
You can also call the Capital Rx Pharmacy Help Desk at 1-844-306-4674.
CareFirst Prescription Drug Coverage (through Capital Rx)
If you’re enrolled in a CareFirst medical plan, your prescription drugs and prescription drug claims are managed by Capital Rx. Wondering if one of your medications is covered by Capital Rx? Find out if your prescriptions are on the formulary—i.e., Capital Rx’s list of approved drugs—and search for approved pharmacies.
You can also review Capital Rx’s approved preventive medications, medications that require prior authorization, and approved pharmacies including JHOP locations.
Looking for on-demand access to your personal prescription information? Access the Capital Rx member app, or follow these step-by-step instructions to create an account.
Quantum Health
Quantum Health is your free healthcare navigator as a CareFirst plan member. They can help you with your prescriptions by answering questions about coverage, finding a pharmacy, or finding the lowest-cost options for a drug. They can also can reach out to your provider to request a refill or a different formulary option.
Contact Quantum Health care coordinators at 1-844-460-2801, Monday through Friday from 8:30 a.m. to 10 p.m., or access the Quantum Health member portal. No request is too big or small for your care coordinator to help.
Mail-Order Prescriptions
Get convenient and cost-effective access to prescription drugs through mail-order delivery. Learn more about how to set up home delivery, request refills of current prescriptions, and more through Optum Home Delivery on the Capital Rx website. If you prefer to use JHOP, call their service center directly to arrange mail-order delivery.
Specialty Medications
Specialty prescriptions are managed by Optum Specialty Pharmacy. Learn more about how to set up, refill, and track your specialty drug prescriptions.
If you prefer that JHOP manages your specialty medication rather than Optum Specialty Pharmacy, call 888-264-0393.
Accessing Dependent Information
Both Capital Rx and Optum Pharmacy follow specific guidelines to safeguard dependents’ protected health information. To learn more about these guidelines and how you can access pharmacy benefits information for your dependents, click here.
Johns Hopkins Outpatient Pharmacy
Available as an alternative to Optum Home Delivery for mail-order and prescription services, Johns Hopkins Outpatient Pharmacy (JHOP) offers a full inventory of standard, specialty, and over-the-counter medications, as well as the convenience of discharge medication processing. You can fill your 90-day supply maintenance medications through one of its outpatient pharmacies or use their mail-order services. Here are the JHOP Locations. To transfer your prescriptions to JHOP, call their service center at 888-264-0393.
Kaiser Permanente Prescription Drug Coverage
Prescription drugs and prescription drug claims for employees and their family members enrolled in the Kaiser Permanente HMO Plan are managed by Kaiser Permanente.
Prescription Drug Use Policy
The University wants to help you use your prescription drug benefits wisely. The following programs will help you get the best medication at the right price:
- Mandatory generics – Generic drugs are lower-cost medications that are just as effective as brand-name drugs. You may pay more if you purchase a brand medicine when a generic-equivalent drug is available. You will pay the generic copay plus the difference in cost between the brand and generic drug.
- Prior authorization – Some medications will require prior authorization, or review and approval, before the plan will cover the cost. This is to ensure that the medication you receive is safe and effective for your situation. Prior authorization may be required for drugs that:
- Have potentially dangerous side effects
- Are harmful when combined with other drugs
- Are often misused
- Are prescribed when less expensive drugs are as effective
- Are specialty medications that are meant to treat very specific diseases and require appropriate clinical markers (biological characteristics that help assess whether a drug will be effective in a specific patient)
- Step therapy – Step therapy requires you to try lower-cost (often generic) medications first, before “stepping up” to medications that cost more. If your medication requires step therapy, you will be obligated to try a step-one medication before stepping up to a step-two (or step-three) medication. Step-one alternative medications are proven to be safe, effective, and affordable, and can provide the same health benefits as more expensive medications, at a lower cost to you.
- Quantity limitations – To reduce waste and ensure that the most cost-effective product strength is prescribed, all medications will be subject to quantity limitations (as determined by the FDA). If your treatment exceeds the quantity limitation of your drug, your prescription will require further authorization.
If your medication needs approval, either you or your pharmacist will need to let your doctor know. Your doctor might switch your therapy to another drug that does not require prior authorization, step therapy, or quantity limitations, by calling Capital Rx or Kaiser Permanente to start the approval process.
To view your prescription drug coverage, including out-of-pocket copays for 30- or 90-day retail or mail-order supplies, view the medical comparison charts for faculty and staff or LiUNA bargaining unit members.