Member Services - Frequently Asked Questions

For cardmembers' convenience, Universal Rx has provided the below list of FAQs. If however, our FAQs do not answer your specific question, please feel free to call us at 540-777-7179. We will do our very best to assist you.


  • Q:  What does it mean when my pharmacy says they do not participate?:
    A:  Universal Rx offers its member cardholders a network of over 65,000 participating pharmacies. A participating pharmacy is one who has contracted with Universal Rx to provide prescription services to Universal Rx cardholders. If a pharmacy has not contracted with Universal Rx to provide such services any prescription claims attempted to be filled by this pharmacy will “reject” or, not process using the cardholders benefits. In such cases the pharmacy can call the Pharmacy Help Desk number located on the member’s drug card to become enrolled and therefore a participating pharmacy. In some cases it may take a short amount of time to enroll the pharmacy and therefore, for the cardholder to utilize their prescription benefits they will have to go to another pharmacy that does participate until their initial pharmacy of choice has been enrolled.

  • Q:  How do I know if my pharmacy participates?:
    A:  Cardholders can select the Retail Pharmacy Network link on the right under Plan Member Resources. A partial list of participating pharmacy chains will be provided. Also included is a link to our Pharmacy Locator where cardholders can enter their zip code and be provided a complete list of participating pharmacies sorted by the distance nearest to their zip code.

  • Q:  What is a Tier 3 drug?:
    A:  Some plan designs now have members utilizing a 3-Tier copayment structure. In such cases each tier is defined as stated below:
    • Tier 3:
      High Cost Brand Name Drugs
    • Tier 2:
      Higher Cost Generic Drugs and Lower Cost “Preferred” Brand Name Drugs.
    • Tier 1:
      Generic Drugs and Selected Low Cost Brand Name Drugs
  • Q:  Are over-the-counter medications covered as part of my prescription benefits?:
    A:  More employers are allowing selected over-the-counter medications to be covered as part of their prescription benefits. In such cases, members will need to obtain a prescription from their physician for the over-the-counter medication and take it to their pharmacy for processing; just like a prescription medication.


  • Q:  What if I lose my drug card and need a prescription filled right away?:
    A:  Members are always encouraged to carry their prescription drug card with them at all times. However, in situations where a drug card is not available and a prescription is needed the pharmacist can call the Pharmacy Help Desk at 1-800-767-4226 to obtain all the necessary information to process the claim.


  • Q:  If I misplace my prescription drug card how can I obtain a new one?:
    A:  If a new prescription drug card is needed, cardholders should notify their Benefits Manager.


  • Q:  Do prices vary among participating pharmacies?:
    A:  Universal Rx contracts a price with each pharmacy. This price includes a discount on prescription medications for cardholders. There are standard rates and guidelines in the industry which are followed; meaning, prices may vary, but usually only slightly.


  • Q:  Does my doctor need to know about my prescription drug coverage when writing my prescription?:
    A:  No; however, you should always consult with your doctor about prescription savings opportunities on prescription medications. This will ensure you are obtaining the most effective drugs for the least expensive price. Please show your physician your plan’s Preferred Drug List (formulary list).


  • Q:  What is a formulary list?:
    A:  Some prescription benefit plans now utilize the three tier co-payment structure. When this co-payment structure is used, members are given a “formulary list” which provides a partial listing of the most commonly used medications and what co-payment tier the medications fall under. If a medication is not on the list, you may contact Universal Rx at 540-777-7179 to determine the tier your medication has been categorized as.

    Formularies help keep drugs affordable by providing medications that are equally effective in treating an illness when compared to the other medications available, but are generally the more cost effective choices.

    Please consult with your physician to discuss which drugs are most appropriate for you.


  • Q:  Who decides what medications are placed in each tier?:
    A:  Universal Rx has an experienced team of clinical pharmacists and physicians who meet regularly to evaluate the most current drugs available along with recent medical findings when deciding which drugs will be placed on the formulary.

  • Q:  Should I ask my doctor to approve a generic substitution whenever possible?:
    A:  Yes, a generic drug is a copy of the brand name medication and typically offers a substantial savings over the brand name drug. Generic drugs must meet quality standards with the Food & Drug Administration. Your prescription benefit is provided to ensure you receive the most appropriate and effective treatment for your individual condition while managing costs for both you and your employer. The generic drug is preferred if your physician has confirmed it is acceptable for you to take it. By using the generic drug, it saves both you and your employer money.


  • Q:  My doctor prescribed a brand medication. Why did I receive a generic?:
    A:  This means the box marked “may substitute” was checked on the prescription. If this box is checked, it means your physician has allowed the pharmacy to substitute the generic drug when there is one available.


  • Q:  Should I provide my doctor with a copy of my formulary list?:
    A:  Yes, by providing your doctor with this list, it provides him or her with beneficial information regarding your prescription drug coverage. By referring to this list they can best determine the preferred medications over the non preferred medications. This could help your doctor determine the most cost effective medication to prescribe, resulting in savings to you.


  • Q:  May I obtain my medications from a non-participating pharmacy?:
    A:  With an extensive pharmacy network of over 45,000 participating pharmacies, it is easier to find a pharmacy in our network than out of the network. If you choose to utilize a non-participating pharmacy, you will pay 100% of the cost of the medication out of pocket. If your benefit plan allows, you may submit a reimbursement claim form along with the original pharmacy receipt; however, this option will usually cost you more than using a participating pharmacy.


  • Q:  How do I transfer my prescription from a non-participating pharmacy to a Universal Rx participating pharmacy?:
    A:  The new participating pharmacy can contact the old non-participating pharmacy and request a transfer of the prescription. You can call the nearest participating pharmacy of your choice and provide the pharmacist with the necessary information from the label on your current prescription; or you can visit the new pharmacy with your medicine bottle and they can obtain the information they need.


  • Q:  Where can I get a summary of my benefits?:
    A:  Most employers distribute a benefits booklet directly to their employees. Contact your employer's benefits office to request this information.


  • Q:  What are your customer service hours?:
    A:  The Pharmacy Help Desk hours are:
                —Monday–Friday, 8:30am-7:00pm and Saturday, 9:00am-3:00pm (ET).
    The Universal Rx Corporate Office is open:
                —Monday–Friday, 8:30am-5:30pm (ET).


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