Mail-order pharmacy program
When you use our mail-order pharmacy, you don’t have to leave the house to get your prescription–it’s delivered right to your door. The shipping is free to anywhere in the United States. For Tier 1 medications that are available in a long-term supply, you can use mail order to get up to a 100-day supply for $0. And, for medications in Tiers 2, 3, and 4 that are available in a long-term supply, you can use mail order to get up to a 90-day supply for the cost of a 60-day supply. That’s a savings of a whole month’s copayment!
Who can use our mail-order pharmacy program?
You must have prescription drug coverage benefits through Fallon Health to use the mail-order pharmacy program.
You can use mail order if you've been on the same medication for several months with no change in dose, and you plan on being on the same medication and dose for a while.
How to fill new prescriptions using mail order
- Ask your doctor to fax or electronically send a new prescription to OptumRx. This is just like when your provider calls it into your regular pharmacy. As long as your provider is contracted with the plan, they'll have all of the information they need to do this.
- Call OptumRx at 1-844-657-0494 (TRS 711) and they'll ask you for your medication and prescriber information, and other information they may need to process your prescription.
- Go online to optumrx.com. (This link takes you away from the Fallon Medicare Plus website.) Register (if you haven’t already) and once you log in, go to "My prescriptions."
- By mail. You can mail your prescription and mail-order form to:
OptumRx
PO Box 2975
Mission, KS 66201
Make sure your doctor writes your mail-order prescription for a 90-day supply for drugs in Tiers 2, 3, or 4 or a 100-day supply for Tier 1 drugs.
How to get refills
We suggest that you request a refill within 7-10 business days from the day you're going to run out of your medication. There are 3 different ways you can order refills through mail order:
- Online. Visit optumrx.com. (This link takes you away from the Fallon Medicare Plus website.) From there you can enter your information to request a refill.
- By phone. Call 1-844-657-0494 (TRS 711). You'll need your prescription information, found on your medication bottle.
- By mail. With each mail-order prescription you'll receive a refill slip with a pre-addressed return envelope that you can mail in.
Pre-packaged medications
You can also have a 30-day supply of your medications individually packaged and labeled by dose, date and time. Each pack is clearly labeled morning, midday, evening and/or bedtime. There is no cost, and they can be delivered right to your home. To learn more, call Customer Service at 1-800-325-5669,
8 a.m.–8 p.m., Monday–Friday (7 days a week, Oct. 1 - March 31).
Frequently asked questions about mail-order pharmacy
Q. How much time do I need to give between ordering a refill and needing to receive it?
A. We suggest that you request a refill within 7-10 business days from the day you're going to run out of your medication.
Q. Can I order a refill as soon as I receive my last shipment?
A. No. You can't order a refill until you've used up 83% for most drugs, 83% for opioid drugs, or 70% for topical ophthalmic drugs of your current shipment. For a 90-day supply, this means for most drugs you can order a refill when you have 2 weeks left of your current shipment.
Q. What medications are available through mail order?
A. Only certain medications are available through mail order. On your formulary (drug list), the last column will be marked with MO if the medication is available through mail order. Please remember that to order a 90-day supply of a drug in Tiers 2, 3, or 4, your prescription must be written for a 90-day supply. To order a 100-day supply of Tier 1 drugs, your prescription must be written for a 100-day supply. Please note that opioid medications are only available in a 30-day supply.
Q. Will my prescriptions be cheaper through mail order?
A. Yes, they can be. For Fallon Medicare Plus members, you pay a 60-day copayment for a 90-day supply for medications in Tiers 2, 3, and 4 when ordering through mail-order. View the chapter called “What you pay for your Part D prescription drugs” in your Evidence of Coverage for more information.
Q. Can I get over-the-counter medications through mail order?
A. You can only get covered medications for which you have a 90-day supply prescription (for drugs in Tiers 2, 3 and 4) or a 100-day supply (for Tier 1 drugs) and that are listed on your formulary (drug list) as available through mail order.
Q. What happens if my medication needs to be refrigerated and it’s delivered on a hot day?
A. We pack medications requiring refrigeration in insulated boxes (or coolers). Additionally, a combination of frozen and ambient gel packs is included with the order, depending on the destination temperature. Should you receive your medication and it's warm, call OptumRx at 1-844-657-0494 (TRS 711) and report the problem. Our team of trained pharmacists and clinicians will gather information from you to determine the condition/ safety of the medication order. If it is determined the medication is damaged, or is at risk of being unsafe, a new order will be shipped to you. OptumRx can also help you get an emergency 30-day supply at your local pharmacy.
Q. What happens if I’m on vacation? Can I get it delivered somewhere else?
A. Yes, as long as you call OptumRx before you ask for your refill, you can have your prescription mailed to you anywhere in the United States.
Q. What happens if someone steals my medication?
A. If your medication is lost or stolen, you should call OptumRx at 1-844-657-0494 (TRS 711) and ask for a refill. You can also get a 30-day supply at your local pharmacy. But, for both situations, the pharmacy must call Fallon Health for an early refill override and explain that it is due to a lost or stolen medication.
Q. What if I run out of my medication before the next shipment arrives?
A. You can get a 30-day supply at your local pharmacy. The pharmacy must call Fallon for an early refill override and explain that it is due to a mail-order delay.
Q. Do I have to pay with a credit card?
A. No. There are multiple ways to pay for your mail-order:
- Check
- Check by phone (ACH)
- Health Savings Account (HSA)or flexible Spending Account (FSA)
- Credit card
Q. What does the package look like? Will my neighbors know that I am getting a box with medications?
A. The package is discreet to maintain confidentiality. It doesn't mention OptumRx.