Concealed Context

Formulate questions that ask for less obvious details. These are often questions about rare exceptions, unusual conditions, or lesser-known facts embedded within the policy. The answer exists but may be hard to find due to its placement in the document.

Question

“How can I order refills for my arthritis medication?”

Answer

“Arthritis is classified as a Specialty Medication If a medication is identified as a Specialty Medication -- it must be filled through mail order by a designated OptumRx Specialty Pharmacy, Optum Specialty Pharmacy or another designated Specialty Pharmacy in the OptumRx Specialty Network. Specialty Medications not filled by a designated OptumRx Specialty Pharmacy, including Network OptumRx Retail Pharmacies, will NOT be covered by the Plan. If Specialty Medications are filled by a non-designated OptumRx Specialty Pharmacy, benefits are NOT paid and You are responsible for 100% of the actual medication cost. For more information, contact the Specialty Pharmacy Referral Line at 1-888-702-8423 (available 24 hours a day, 7 days a week).

Excerpts from the Source Document:

Under the Covered Health Services heading:

Page 65 includes the prescription coverage.

Prescriptions – Plan Coverage Each Prescription Drug Tier is assigned a cost (Copayment or Coinsurance) which is the amount You pay at a retail pharmacy, or the amount You pay if You have Maintenance Medications filled through the Plan’s mail order program. Your Out-of-Pocket Prescription costs apply to the Plan’s Deductible and Out-of-Pocket Maximum accumulators. The information following is a Plan coverage overview applicable to all UnitedHealthcare Medical Plans. Exceptions apply to the HSA Medical Plan. Refer to "Prescriptions - HSA Medical Plan" to review Plan coverage. For more information about Prescription coverage details for all Plans, refer to Medical Plan Comparison Chart. Prescriptions – Summary of Coverage Tier - 1 o Covered at 100% after Copayment Tier - 2 o Covered at 100% after Coinsurance o Plan Deductible – Not Applicable o Assigned Out-of-Pocket Prescription cost “minimum” and “maximum” apply o Your cost will be no less than the assigned minimum o Your cost will not exceed the assigned maximum Tier - 3 o Covered at 100% after Coinsurance o Plan Deductible – Not Applicable o Assigned Out-of-Pocket Prescription cost “minimum” and “maximum” apply o Your cost will be no less than the assigned minimum o Your cost will not exceed the assigned maximum Specialty Medications o Special fill requirements apply to Specialty Medications o Must be filled at a Specialty Pharmacy, Optum Specialty Pharmacy or other OptumRx designated Specialty pharmacy providers o 31 Day Supply Only

Page 68 lists example of specialty medication.

Specialty Medication - Examples Specialty Medications are used to treat rare, unusual, or complex medical conditions including, but are not limited to the medications included in the table below. Self- administered diabetes products are not classified as a Specialty Medication. Allergic Asthma Immune Deficiency Anaemia Fertility Arthritis Multiple Sclerosis Cancer Cystic Fibrosis Endocrine Disorder Osteoporosis Enzyme Deficiency Parkinson’s Disease Excess Iron Psoriasis Growth Hormone Deficiency Pulmonary Arterial Hypertension Haemophilia Respiratory Syncytial Virus Hepatitis B Thrombocytopenia Hepatitis C Transplant HIV/AIDS Vaccines

To answer this question correctly, it is crucial to identify that arthritis falls in the category of specialty medication. The procedure for specialty medication refill is different from normal medication. This information is obscured inside a large table. An AI agent may have difficulty extracting this information. If this information is not retrieved, the AI agent may incorrectly provide advice on how to refill regular medication.