Do you have questions about switching to Optum Rx? We’ve got answers.
Who is Optum Rx?
Optum Rx provides safe, easy and cost-effective ways for you to get the medication you need and will be your pharmacy benefits manager beginning in 2024.
We are committed to helping you get the most out of your pharmacy benefits and make this move as easy as possible. Below are the answers to frequently asked questions.
Will I receive a new ID card?
Yes, you’ll receive a combined medical and pharmacy ID card by the end of December. If you have not received a new ID card by then, please contact us at 888-438-9135.
Will the medication I’m currently taking be covered with Optum Rx?
To learn if your medication is covered, go to compassrosebenefits.com/optumrx. You may also log in to optumrx.com beginning January 1 to check your plan’s formulary. A formulary is a continuously updated list of prescription drugs and provides how they are covered.
Do my medications need prior authorization?
Some medications may need prior authorization to ensure you receive medications that are safe, effective and provide the greatest value. If your medication needs prior authorization, your provider will need to let us know why you are taking the medication to determine if it will be covered under your pharmacy benefit.
You may call Optum Rx at 888-438-9135 or go to compassrosebenefits.com/optumrx and click on Prescription drug list to confirm if your medication requires a prior authorization. If your medication requires a prior authorization, your provider may complete the prior authorization beginning January 1, 2024.
If I have a prior authorization currently, will it transfer to Optum in 2024?
Current prior authorizations with a 2024 term date or later will transfer to Optum Rx to allow a one-month grace period following the switch to Optum Rx. Your provider will need to complete a new prior authorization by January 31, 2024. You and your provider should confirm if your medication requires a prior authorization with Optum Rx. Your provider may complete the prior authorization beginning January 1, 2024.
What pharmacy can I use?
The Optum Pharmacy Network is comprised of major chains, grocery store pharmacies, and many independent pharmacies throughout the United States. You can use the Pharmacy locator tool at compassrosebenefits.com/optumrx to find pharmacies nearest you. Beginning January 1, you will also be able to use the Optum Rx app or log in to your account at optumrx.com to view a list of network pharmacies.
Home DeliveryIf you take a medication regularly, you could save time and money with Optum® Home Delivery.
- Order a 3-month supply.
- Get your medications delivered right to your mailbox — with free standard shipping.
- Talk to a pharmacist 24/7.
Will my current home delivery prescription(s) transfer to Optum Home Delivery?
Most home delivery prescriptions with valid refills remaining will transfer to Optum Home Delivery. However, prescriptions for some medications, like controlled substances and ones that have expired, will not be transferred. In these cases, you’ll need a new prescription from your doctor.
Will my home delivery billing information also transfer to Optum Home Delivery?
To keep personal information safe, payment information cannot be shared between pharmacies. You will need to provide your preferred payment method to Optum Home Delivery before your first order can be shipped. Once your payment information is complete and your order is placed, medications will typically arrive within 5 days.
How will I order my prescriptions from Optum Home Delivery?
Once your coverage begins on January 1, there are several ways to place a home delivery order:
- Go online to optumrx.com, download the Optum Rx app or contact Optum Rx by phone at 800-557-5785.
- Your doctor can send an electronic prescription to Optum Home Delivery. Prescriptions for controlled substances, such as opioids, can only be ordered by e-prescribe.
Optum® Specialty Pharmacy will be your specialty pharmacy. Optum Specialty Pharmacy does more than just fill prescriptions. They provide the resources and personal support you need when you need it.
What are specialty medications?
Specialty medications are for conditions such as cancer, multiple sclerosis and rheumatoid arthritis. They can be injectable, taken by mouth or inhaled. They also:
- May require ongoing clinical oversight and additional education for best management.
- Have unique storage or shipping requirements.
- May not be available at retail pharmacies.
To learn more about specialty services:
- Visit specialty.optumrx.com/new-fill. Optum Specialty Pharmacy will contact your doctor and take care of everything else.
- Call a specialty representative at 866-306-8900
- Text NEW to 55455
Please contact us at 888-438-9135 8 am to 8 pm ET.