Answers to frequently asked questions about the Consumer Driven Option pharmacy program

OptumRx is a UnitedHealth Group company, offering high quality pharmacy benefit services. You can be confident that your prescription claims will be processed quickly and accurately. You will also enjoy additional advantages, such as an easy online experience, option to set up mobile text refill reminders, superior customer service and access to our in-house mail service pharmacy.

Yes, in the next few weeks, you’ll get a new Health Plan ID card with OptumRx information on it. The new card will not be valid until you’ve moved to OptumRx (the date shown in the enclosed letter). Please keep and use your current card until that date. You can dispose of your old Health Plan ID card when the new card becomes effective. Remember to share your new Health Plan ID card at the pharmacy and next doctor visit. This will help prevent future billing issues and ensure your updated information is on file.

If you do not receive your new Health Plan ID card by the time you move to OptumRx, you can download and print a temporary Health Plan ID card on your Health Plan’s website. A permanent card can be requested by logging in to your Health Plan’s website or by calling the member number on the back of your Health Plan ID card.

The OptumRx network includes over 64,000 retail pharmacies, including all large national chains, many local, community pharmacies and the OptumRx Mail Service Pharmacy. It compares in size to the network you have today. To search for a network pharmacy near you, log in to the member website on your new Health Plan ID card and visit the pharmacy section. Or call the member phone number on the back of that card. There should be little, if any, disruption to members. If a pharmacy is no longer in our network, and you’ve filled a prescription there in the past three months, we’ll notify you by mail.

Some members may experience a change. For example, medication prices may vary between pharmacies. You may see a difference if you or your employer recently selected a new benefit plan. Additionally, if you haven’t yet met your deductible and you’re paying out of pocket for your medication, you may see a cost increase or decrease between fills.

We anticipate there will be no change to your benefit coverage as a result of the move to OptumRx. Your employer may choose to update benefit plans during Open Enrollment. Additionally, as part of your pharmacy benefit plan, Prescription Drug List (PDL) updates generally occur once or twice a year, depending on the plan. Any PDL or health and pharmacy benefit changes made during open enrollment are separate and not related to the move to OptumRx.

As long as your authorization has not expired, you will not need to go through the process again when you move to OptumRx. Before your current authorization expires, please ask your doctor to contact OptumRx to renew your authorization. You can find the expiration date in your original authorization letter.

Yes, you can still access your prescription and mail service information online. Once you’ve moved to OptumRx (the date shown in the enclosed letter), just log in to the member website on your new Health Plan ID card and visit the pharmacy section. You can quickly view your medications, check status and refill mail service prescriptions. You will also see transferred mail service prescriptions that may be eligible for refills. Placing an online refill order is easy. You simply need to provide a payment method during the checkout process. You can also set up refill reminders to send to your mobile phone. Once you’ve moved to OptumRx, Medco information will no longer be shown.

After you move to OptumRx, log in to your Health Plan’s member website to view and manage all your dependents information under the age of 13. Within the pharmacy section of the site, click on the My Prescriptions tab. On the left side of the page, you can select your dependent’s account by using the View Accounts drop-down box. In order to protect the privacy and personal health information of our members, OptumRx has adopted a process for you to request permission to access your dependent(s) or spouse’s prescription information. To set up access, your covered dependent or spouse will need to log in to your Health Plan’s member website. Then, within the pharmacy section of the site, click on the My Account tab and follow the steps under Household/Caregiver Access.

Most mail service prescriptions with remaining refills will automatically transfer. Prescriptions for certain medications, like painkillers, will not transfer. In this case, you’ll receive a letter from UnitedHealthcare. Prescriptions that do not transfer, including expired prescriptions, will require a new prescription from your doctor. OptumRx will contact you when it’s time to process your refill order.

You’ll need a new prescription if there are no more refills for your medication. You can contact your doctor for a new prescription. Or, when you’ve moved to OptumRx, we can work directly with your doctor.

New and transferred prescription orders are delivered by standard U.S. mail and will arrive around 10 business days from the date OptumRx receives the order. Refills are sent the same way and normally arrive within 7 business days of OptumRx receiving your order. If you have an email address on file, you can expect to receive an email when your prescription ships. If you don’t have an email address on file, you’ll receive a phone call.

Brand medications will look the same as your current prescription. Generics may look different, as OptumRx may use a different manufacturer for some medications. You can rest assured that U.S. Food and Drug Administration (FDA) approved generic medications are required to be the same strength and follow the same quality standards. If you have questions about your medications, our registered pharmacists are available 24 hours a day, 7 days a week.

Once you’ve moved to OptumRx (the date shown on the enclosed letter), there are several ways you can place new mail service orders and refills:

Online: Log into the member website listed on your new Health Plan ID card and visit the pharmacy section

Mail: Mail in your prescription with a completed order form. This form can be found by logging in to the member website on your new Health Plan ID card

Phone: Call the member phone number listed on the back of your Health Plan ID card for the OptumRx Mail Service Pharmacy, 24 hours a day, 7 days a week

Your doctor can also fax, speak to a pharmacist or e-prescribe a new order for you

Many members use mail service for the convenience, safety and savings. Medications are delivered directly to your home, which means fewer trips to the pharmacy. You will receive a 3-month supply, which may save you money. Registered pharmacists are available 24 hours a day, 7 days a week to answer questions. And you can feel confident in OptumRx’s 99.99% mail service accuracy rate. All prescriptions go through multiple checks by licensed pharmacists and technicians, and are screened for potential harmful interactions with other medications on file. To learn more about mail service, log in to the member website listed on your new Health Plan ID card and visit the pharmacy section.

You are responsible for any outstanding payments to Medco. Payments will be billed to the credit card on file with Medco in the same 30-day increments until they are paid in full. Your balance will not transfer.

If you use the Medco Worry Free Fill program, you will have an additional letter in the enclosed material confirming that your enrollment in the program is ending and letting you know how to enroll in the new OptumRx automatic refill program, Hassle-Free Fill℠. To continue receiving automatic refills, you will need to enroll all your eligible mail service prescriptions in the Hassle-Free Fill program with OptumRx. You can enroll in two ways:

1. Call the number on the back of your Health Plan ID card.

2. Wait for OptumRx to contact you 2-3 weeks prior to your first refill date and enroll at that time.

No, you do not need to take action. There are no changes to your benefits or services as a result of the move to OptumRx. Please continue to order your specialty prescriptions from OptumRx by calling 1-888-739-5820.

For added convenience, you have access to one phone number for both your medical and pharmacy questions. If this FAQ has not answered your question, simply call customer service at the member phone number listed on the back of your Health Plan ID card. Please look carefully, as there are several phone numbers listed. Call the “For Members” phone number provided.