Find your prescription drug

Visit our Pharmacy Finder to locate in-network pharmacies, see if a prescription medication is covered, and find out what your out-of-pocket costs will be. You can also view our flyer to learn more about how to use these tools.

Individual members: Find your prescription drugs

Online search:

Find my drug

Here you can:

• Estimate the price of a drug
• See which retail pharmacies are in-network for most plans
• See how drugs are covered and other formulary information

Group members: Find your prescription drugs

Online search

• 3-Tier Open Group
• 5-Tier Closed Group (FID 00026200)
• Select Value 2026 (FID 00026201)
• 5-Tier Group

Save money on your prescriptions

You may be able to pay less for your medications by:

• Using a preferred pharmacy
• Choosing generic drugs
• Switching to mail order

Standard vs. preferred pharmacies

Some pharmacies offer lower costs. These are called preferred pharmacies. You can use any in-network pharmacy, but you may save money at preferred locations.

• Tier 1 and 2 drugs (most generics): Lower cost at preferred pharmacies
• Tier 3, 4, and 5 drugs (brand-name, specialty, and high-cost generic drugs): Same cost at all pharmacies

Find an in-network pharmacy

To find an in-network pharmacy or confirm that one is in your network:

Find a pharmacy

Mail-order pharmacy

You can have your prescriptions delivered to your home through OptumRx^® Home Delivery. This is a simple and convenient option, especially for medicines you take regularly.

Benefits of mail order

• Free shipping
• 24/7 pharmacist access
• Language support (including Spanish and large print)
• Caregiver access

You may pay:

• $0 for Tier 1 preferred generic drugs
• $0 for Tier 2 generic drugs

How to use mail order

To switch from a retail pharmacy:

• Log in at ibx.com/login or
• Call 1-888-678-7015 (TTY/TDD: 711) 7 days a week, 24 hours a day to find out if the prescription is eligible and ask to change to mail order.

Have this information handy:

• Name and address
• Prescription number
• Billing information

For a new prescription:

• Ask your doctor to send it to OptumRx Home Delivery
• OptumRx Home Delivery will call you to confirm any details. Pharmacies must get consent prior to shipping or delivering any prescriptions that your prescriber sends.

To refill a prescription:

You can:

• Sign up for automatic refills by logging in ibx.com/login
• Call 1-888-678-7015 (TTY/TDD: 711) 7 days a week, 24 hours a day.
• Fill out and send in the Prescription Mail-order Form.

If you do not use auto-refill, contact the pharmacy 7 to 10 days before you run out.

Note: OptumRx Home Delivery is the only mail-order pharmacy in the plan’s network. You must use OptumRx Home Delivery for mail-order services.

Out-of-network coverage

In some cases, your plan may cover up to a 30-day supply if at least one of the following applies:

• A medical emergency
• No nearby network pharmacy that provides 24-hour service
• A drug is not available at network pharmacies or mail-order pharmacy

You will likely:

• Pay more up front
• Need to submit a claim for reimbursement

Submitting a claim

If you pay for a prescription yourself at an out-of-network pharmacy:

1. Fill out the Direct Member Reimbursement Form.
2. Send it with your receipt.

You will be reimbursed based on the plan’s allowed amount. We cannot cover prescriptions filled outside of the United States.

Additional reimbursement forms:

• Part D Vaccine and Administration Direct Member Reimbursement Form — this form is for Part D vaccines only and should not be used for Part B vaccines such as the flu shot.
• Influenza Vaccine Reimbursement

Searchable formulary document

A formulary is a list of drugs your plan covers. It is:

• Reviewed by doctors and pharmacists
• Approved by Medicare
• Updated during the year

Certain medications need our approval before your plan covers them, a process known as prior authorization.

Sometimes, your plan may also require you to try a different medication first before we will cover those drugs. This is known as step therapy.

Learn more about prior authorization and step therapy requirements.

2026 formularies, prior authorization criteria, and step therapy criteria for individual members

Keystone 65 Basic Rx HMO

• Keystone 65 Basic Rx HMO Formulary
• Keystone 65 Basic Rx HMO Utilization Management Criteria – Prior Authorization
• Keystone 65 Basic Rx HMO Utilization Management Criteria – Step Therapy

Keystone 65 Essential Rx HMO-POS

• Keystone 65 Essential Rx HMO-POS Formulary
• Keystone 65 Essential Rx HMO-POS Utilization Management Criteria – Prior Authorization
• Keystone 65 Essential Rx HMO-POS Utilization Management Criteria – Step Therapy

Keystone 65 Focus Rx HMO-POS

• Keystone 65 Focus Rx HMO-POS Formulary
• Keystone 65 Focus Rx HMO-POS Utilization Management Criteria – Prior Authorization
• Keystone 65 Focus Rx HMO-POS Utilization Management Criteria – Step Therapy

Keystone 65 Preferred Rx HMO

• Keystone 65 Preferred Rx HMO Formulary
• Keystone 65 Preferred Rx HMO Utilization Management Criteria – Prior Authorization
• Keystone 65 Preferred Rx HMO Utilization Management Criteria – Step Therapy

Keystone 65 Select Rx HMO

• Keystone 65 Select Rx HMO Formulary
• Keystone 65 Select Rx HMO Utilization Management Criteria – Prior Authorization
• Keystone 65 Select Rx HMO Utilization Management Criteria – Step Therapy

Personal Choice 65 Rx PPO

• Personal Choice 65 Rx PPO Formulary
• Personal Choice 65 Rx PPO Utilization Management Criteria – Prior Authorization
• Personal Choice 65 Rx PPO Utilization Management Criteria – Step Therapy

Personal Choice 65 Achieve Rx PPO

• Personal Choice 65 Achieve Rx PPO Formulary
• Personal Choice 65 Achieve Rx PPO Utilization Management Criteria – Prior Authorization
• Personal Choice 65 Achieve Rx PPO Utilization Management Criteria – Step Therapy

Personal Choice 65 Plus Rx PPO

• Personal Choice 65 Plus Rx PPO Formulary
• Personal Choice 65 Plus Rx PPO Utilization Management Criteria – Prior Authorization
• Personal Choice 65 Plus Rx PPO Utilization Management Criteria – Step Therapy

2026 formularies for group members

3 Tier Open Group

• 3 Tier Open Group Formulary
• 3 Tier Open Utilization Management Criteria – Prior Authorization
• 3 Tier Open Utilization Management Criteria – Step Therapy

5 Tier Closed Group (FID 00026200)

• 5 Tier Closed Group Formulary (FID 00026200)
• 5 Tier Closed Utilization Management Criteria – Prior Authorization
• 5 Tier Closed Utilization Management Criteria – Step Therapy

Select Option Value 2026: (FID 00026201)

• Select Option Value 2026 (FID 00026201)
• Select Option Value 2026 Utilization Management Criteria – Prior Authorization
• Select Option Value 2026 Utilization Management Criteria – Step Therapy

5 Tier Open Group

• 5 Tier Open Group Formulary
• 5 Tier Open Utilization Management Criteria – Prior Authorization
• 5 Tier Open Utilization Management Criteria – Step Therapy

Need help?

You can contact us for the most up-to-date drug list.

To learn about exceptions to the plan’s formulary or to file an appeal or grievance, visit:

• Coverage determinations for Part D drugs
• Part D Appeals
• Part D Grievances

Y0041_HM_125391_M_2026
Website last updated: 5/20/2026