OptumRx resources for providers

Thank you for providing critical services to consumers during this challenging time. We are here to help support you as you continue to deliver these essential services.

OptumRx is monitoring the impact across the country from the COVID-19 situation and is taking further action to assist health care providers, clients and members.

As new and rapidly evolving information is known, OptumRx is assessing our policy to ensure we continue to meet the clinical needs of our members and comply with applicable CDC guidance, as well as federal, state and local government requirements.

OptumRx is implementing these policy changes to support our clients, members and providers during this time.

Policy applicability

The policies outlined below apply to clients that use OptumRx formularies and the OptumRx National Pharmacy & Therapeutics Committee. This includes all direct commercial, Medicare and most public sector plans. Health plans and fee-for-service (FFS) Medicaid clients do not have the policy in effect and have the option to opt into the policy if they choose.

Prior authorization (PA) extensions

To meet the clinical needs of our members and to limit the burden on a stressed provider network amid the COVID-19 outbreak, OptumRx is extending some existing PAs that are set to expire on or before May 1, 2020. This policy will go into effect March 19, 2020, at 12 p.m. (noon) CST.

• The one-time 90-day extension will be made to existing PAs for medications generally taken on a chronic basis.
• This extension will ensure that convenient access to critical medications is maintained during this period when vulnerable populations are being directed to take precautionary measures.
• PAs for drugs with significant abuse potential (i.e., opioids) or those that are generally dosed for finite durations or intermittently (i.e., hepatitis agents, fertility agents) will not be extended. These PAs will follow the normal process for renewals.
• PA requirements for newly prescribed medications will remain in place.
• This policy is in effect for all regions and states covered by OptumRx. OptumRx will continue to monitor the COVID-19 situation to determine whether further action is needed.
  
  

E-prescribing requirement for controlled substances (EPCS) will resume beginning July 1, 2020

Starting July 1, 2020, OptumRx home delivery pharmacy will lift the temporary on-hold status of our electronic prescribing requirement for opioid and other controlled substances. As of this date, we will no longer fill prescriptions received by hard copy, fax or phone for these medications to help increase patient safety and reduce potential fraud.

If you or your practice are planning to become certified in 2020, and won’t be live by July 1, 2020, please email EPCSquestions@optum.com to ask about an exemption.

Exceptions: Currently, this requirement doesn’t apply to:

• Members living in Alaska, Guam, Puerto Rico or the U.S. Virgin Islands
• Prescribers who are exempt from state EPCS requirements or the CMS SUPPORT Act EPCS exceptions
• Practitioners who have demonstrated other exceptional circumstances

If you’re unable to submit e-prescriptions due to a hardship, or your patient is unable to go to their local pharmacy to pick up a prescription, you can ask for an exception. Please email your exception request to EPCSquestions@optum.com.

EPCS resources  

If you still aren’t EPCS certified, please check out our landing page for instructions, frequently asked questions and more. 

Home delivery support during COVID-19

At OptumRx, we take your patients' health seriously. This is even more important with the recent spread of COVID-19. We understand patients may prefer having prescriptions delivered to them in the current environment.

Consider OptumRx home delivery, which includes:

• Free two-day shipping on all standard orders.
• 70% of orders ship within one day. Overnight delivery available via FedEx for urgent prescriptions.*
• 24/7 patient access to a pharmacist via phone.

*Based on 55M scripts shipped in 2018, internal HDP reporting.

Questions about home delivery? Visit this page to watch a quick video and learn more. 

How does home delivery work?

• Physician sends ePrescription to OptumRx or member requests refill.
• OptumRx processes order and calls to verify address and credit card.
• Pharmacist checks for accuracy with 16 safety checks and fills order.
• OptumRx ships medication in tamper-evident, eco-friendly packaging.

Learn more about OptumRx members' frequently asked questions here.