OptumRx resources for providers
Learn how health care professionals can support consumers’ pharmacy needs through the COVID-19 pandemic.
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.
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.
ePrescribing requirement for controlled substances now "on hold"
As a result of the current COVID-19 pandemic and its impact on the health care community, OptumRx home delivery is placing the implementation of our mandatory ePrescribing policy for controlled substances (EPCS) temporarily “ON HOLD.”
As was previously communicated, e-Prescribing of controlled substances to OptumRx home delivery pharmacy was to become a requirement by March 1, 2020, in an effort to increase patient safety and reduce fraud.
Effective immediately, the EPCS requirement is now on hold until future notice. Any controlled substance prescription received by home delivery will be filled as long as it meets federal and state regulatory requirements.
- Any provider or member exemption will remain on file for a year from the date it was submitted.
- There is no change in the exemption process; you can still email those requests to EPCSquestions@optum.com.
- Updated communication will be shared as soon as OptumRx home delivery pharmacy determines when the EPCS requirement will resume.
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.