To be eligible, drugs must be listed on one of Walmart's formularies, which are the lists of covered prescription drugs. The formulary prioritizes effective medications at a lower cost to you–with over 250 medications on the new Zero Dollar tier, including some insulins and inhalers. Saver HSA Plan participants must pay the entire cost of covered medications until the network deductible is met. There are exceptions for preventive medications.

The formulary lists can be found using the OptumRx website. You can also call OptumRx at 1-844-705-7493 to ask about a particular drug. The list of covered prescription drugs (maintained by TruDataRx) is reviewed quarterly and often changes.

Some brand-name and other prescription drugs aren’t covered because generic or over-the-counter alternatives have proven to be just as effective. To see whether your medication will be covered and under which copay, review the list of prescription medications. For more information about what is and is not covered, see the pharmacy benefit section of the Associate Benefits Book.

Specialty drugs under the Premier PPO, Saver HSA, Contribution HRA, and Personalized Wellbeing Copay Plans must be purchased through Walmart Specialty Pharmacy, except fertility medications filled through Kindbody’s specialty pharmacy, and limited distribution drugs that are not available through Walmart Specialty Pharmacy. You should call Walmart Specialty Pharmacy to ask about the availability of your prescription drugs under the plan.

Some prescription drugs require prior authorization. Call OptumRx at 1-844-705-7493 to see which drugs are affected. 

In 2027 there will be a new administrator for pharmacy benefit prior authorization and appeals: TruDataRx. You may hear from TruDataRx about your prior authorization if your coverage for prescription medications has changed. TruDataRx will also own and maintain the new formulary (the plan’s list of covered prescription medications) which you can find through OptumRx.

For questions about prior authorizations, non-formulary clinical reviews, or appeals, call TruDataRx at 1-833-575-0755. Providers may fax prior authorization requests to TruDataRx at 1-888-707-7324. For pharmacy network questions, formulary lookup assistance, or other customer service questions, call OptumRx at 1-844-705-7493.

If you’re in the Premier PPO, Saver HSA, Contribution HRA, or Personalized Wellbeing Copay Plan, you must generally use a Walmart, or Sam's Club, or Optum Home Delivery for maintenance medications, or a Walmart Specialty Pharmacy for specialty medications, to get your pharmacy benefit, unless a geographic network exception applies. All other pharmacies are considered out-of-network, and in most cases, you'll pay the full retail price. Call OptumRx at 1-844-705-7493 for details regarding pharmacy network.

Some circumstances allow you to fill prescriptions outside the pharmacies listed above, including acute, after hours, and emergency fills.

You can get a 30, 60, or 90-day supply of a generic maintenance medication or a 30-day supply of a brand drug when you use Optum Home Delivery pharmacy. You’ll pay three times the cost of a 30-day supply when you order a 90-day supply.