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Pharmacy Benefits

The WTC Health Program has partnered with Team MCA (Managed Care Advisors & Optum) to provide prescription benefits for members with certified WTC-related conditions. Their national pharmacy network offers ease of access to over 65,000 retail pharmacy network locations including all major pharmacy chains, independent outlets, national clinics, and compounding pharmacies. A convenient mail order program allows members with certified WTC-related conditions to have their medications delivered directly to their home. Optum’s pharmacy services are built on best-in-class programs that ensure convenience and safety for members.

The WTC Health Program will have a new Pharmacy Benefit Manager effective June 1, 2022. Learn more and get updates on the PBM Transition Page.

Pharmacy Updates

  • November 09, 2021 – The World Trade Center (WTC) Health Program Pharmacy Benefit Manager (PBM) contract has been awarded to Express Scripts Inc. Express Scripts will replace the current PBM, Managed Care Advisors (MCA) and Optum, June 1, 2022. The PBM provides coverage for prescription drugs to WTC Health Program members. More information will be sent to members while the Program transitions from MCA/Optum to Express Scripts over the next few months. Please visit https://www.cdc.gov/wtc/pbmtransition.html for the most updated information on this change.
  • June 1, 2021 – The 30-day supply limit on medication fills at a retail or community pharmacy will be reinstated on August 1, 2021. This limit was lifted temporarily in response to the COVID-19 pandemic.
  • August 19, 2020 – New Flu Vaccine page explains why members should get a flu vaccine and how to get one covered by the Program.
  • January 24, 2020 – BriovaRx re-named Optum Specialty Pharmacy Learn more
  • July 19, 2019 – Pharmacy Benefits Change for Prescription Fills at Retail Pharmacies Learn more
  • May 6, 2019 – Optum has launched a new prescription home delivery website specifically for WTC Health Program members. Learn more
  • September 1, 2018 – Starting on December 1, 2018, the WTC Health Program will limit the types of over-the-counter products that will be covered by the Program. Learn more
  • April 25, 2018 – The home delivery pharmacy provider changed from Walgreens to OptumRx (non-specialty medicines) and BriovaRx (specialty medicines). Learn More

For Survivors: Coordination of Benefits

Survivors in the WTC Health Program are required by the James Zadroga 9/11 Health and Compensation Act to have all prescriptions billed to primary insurance first before they are billed to the WTC Health Program. This is known as “Coordination of Benefits”. Learn more about how this works and what you need to do on the Coordination of Benefits page.

Your Prescription Medicine: Tips for Safe Storage and Disposal

How and where you keep your medication can make a big difference when it comes to safety. Learn how best to store your medication, find where to dispose of unused or unwanted medication, and download an informative fact sheet or postcard for quick reference on the Prescription Safety page.

Still have questions?

Visit the Frequently Asked Questions (FAQs) or call Optum at 1-855-640–0005. You can also learn more by visiting the Pharmacy Benefits section of the Member Handbook