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City of Milwaukee Pharmacy Benefits

The City's pharmacy benefits are through UnitedHealthcare OptumRx.  Visit myuhc.com to find a pharmacy near you, under Pharmacies & Prescriptions, or call the phone number on the back of your health plan ID card.   

Your UnitedHealthcare ID card includes information for your pharmacy on the bottom right of the card.  

If employees have questions about prescription coverage call the number on the back of the card. 1-800-841-4901.

Prescription Drug Coverage under UnitedHealthcare (UHC) Choice EPO and UnitedHealthcare (UHC) Choice Plus PPO plans:

Prescription Drug Coinsurance (employee pays) does not apply to medical deductible or out-of-pocket maximum

  • Retail and Specialty (30 day supply):  20% ($4 min; $75 max)
  • Mail order (90 day supply):  20% ($8 min; $150 max)
  • Prescription Drug Out-of-Pocket Maximum:  $3,600 individual/$7,200 family

Prescription Drug Coverage under UnitedHealthcare (UHC) High Deductible Health plan:

Prescription Drug Coinsurance (employee pays) combined medical and prescription drug deductible. Employee pays 100% until deductible has been met and 20% until the out-of-pocket has been met.

  • Retail and Specialty (30 day supply):  20% after deductible ($4 min; $75 max)
  • Mail order (90 day supply):  20% after deductible ($8 min; $150 max)

Pharmacy Plan Documents:

Legal Notices:

Summary of Benefits and Coverage and Summary Plan Descriptions

UnitedHealthcare (UHC) EPO Choice Plan:

UnitedHealthcare (UHC) PPO Choice Plus Plan:

UnitedHealthcare High Deductible Health Plan

Appeal Information:

Can I appeal a prescription drug decision?

If a claim for Benefits is denied in part or in whole, you may call UnitedHealthcare at the number on your ID card before requesting a formal appeal.  If UnitedHealthcare cannot resolved the issue to your satisfaction over the phone, you have the right to file a formal appeal as described below.

How to Appeal a Denied Claim

If you wish to appeal a denied pre-service request for Benefits, post-service claim or a rescission of coverage as described below, you or your authorized representative must submit your appeal in writing within 180 days of receiving the adverse benefit determination.

UnitedHealthcare - Appeals

P.O. Box 30432

Salt Lake City, UT 84130-0432

Phone:  1-800-841-4901

Submit an appeal online here

How long does the appeal process take?

First level appeals can take up to 30 calendar days from when your request is received. You will receive written notice of the decision.

What if my appeal is urgent?

In some cases, rush appeals can be reviewed, and a decision could be made within 72 hours. Generally, you can request an urgent decision for these reasons:

  • Life, health or ability to function would be in jeopardy based on layperson’s judgement
  • You may be subject to severe pain without the treatment or care requested in the opinion of a clinician who is aware of your condition.

You may request an urgent appeal by calling the number above during the hours stated.

You do not need to go through the internal appeal review if:

(a) we fail to meet our internal appeal process timelines, or

(b) you have an urgent care situation and you have requested an external review, or

(c) we decide to waive the internal appeal process requirements.

Contact Us

ACTIVE Employees

Employee Benefits Division
Department of Employee Relations
200 E. Wells Street, Room 706
Milwaukee, WI 53202-3515

Contact Us

RETIRED Employees

Employes' Retirement System (ERS)
789 N. Water Street, Suite 300
Milwaukee, WI 53202-3584

CLICK FOR ACTION (request City services)
(414) 286-CITY (2489)

TDD: (414) 286-2960

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