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.
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.
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.
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.
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.
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.
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.
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.
Once your coverage begins on January 1, there are several ways to place a home delivery order:
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.
Specialty medications are for conditions such as cancer, multiple sclerosis and rheumatoid arthritis. They can be injectable, taken by mouth or inhaled. They also:
To learn more about specialty services:
Please contact us at 888-438-9135 8 am to 8 pm ET.