I’m considering Rx coverage that includes Optum Rx mail order as a 90-day supply source of medication. I have zero experience with this company. Can you give any experience with this firm?
What’s customer service like?
Do they play well with the doctor’s Rx communication?
Do they execute their function well or do they need a lot of supervision?
I’ve used Express Scripts most recently and have been happy with them.
I’ve had OptumRx for a few years now. No problems with them. Customer service? I very rarely need to call them about anything. The meds just show up every three months. I recommend them
I have been with Optum Rx, and it was a good experience. No issues with their ordering process, customer service or quickly resolving any of the few minimal issues that came up.
I expect to change my part D shortly for the 2024 Medicare year plan. The plan I am most interested in uses Optum Rx, and I have no hesitation using them again, being MDI my 90-day drug, supplies, including my insulin, will come from them. No worries.
Thanks for the useful replies, @Michelle43 and @CJ114. Reading both of your positive reports brightens my day!
Optum Rx does not appear to use PAs or prior authorizations as a way to manage Medicare Part D Rx patients. I detest PAs as it seems like a dodgy way to delay and then say “no.”
Medicare.gov allows you to put in an exact list of Rx’s so when it gives you coverage details, it seems the PA tool is not necessary.
I have had them about 16 months, no issues.
My confidence in this possible choice increases some more! Thanks for reporting your experience, @Rphil2.
I have had Optum Rx for 20 plus years??? 5 years on Medicare. Overall I do like them. They are not without some issues off and on over the years, Usually their communication via e-mail is pretty good about letting you know what is going on. (I’ve chosen e-mail, not text because of the time difference). Waiting for a new refill approval, waiting for a pharmacist review, call the pharmacist etc. They let you know when it’s sent, and when it’s actually delivered. Refills usually are no problems, it’s the brand new scripts that can have hang ups off and on and they want their pharmacist to review it and talk to you to “clarify” the script. They have always approved it after I’ve talked to them. Their website is great for the most part. The 3 month supply from them for my plan is cheaper.
But overall, their customer service has been really good. Easy to get hold of and they always try to find out what you need to know.
I appreciate your comment, @Marie20. No company (or person for that matter!) is perfect and your perspective reminds us of that. Bottom line, Optum Rx seems to be a responsible corporate player that provides a good basic service and doesn’t waste your time, at least not too much. Thanks.
OptumRx is the PBM and mail order pharmacy for my insurance plan. I’m not on medicare so my experience may be different. I absolutely trust that OptumRx will deliver my medications. My previous mail order pharmacy was Caremark and OptumRX is way better.
There are some areas OptumRx needs improvement. I don’t know what is important to you so here is a whole pile of info.
Still better than Caremark.
Yikes! Your experience is definitely different than previous comments. Thanks for your report.
@spdif I’m not saying you didn’t have a bad experience. Some people can have nightmare experiences with some companies. I am on a state plan too, first non retired and now retired and now it supplements Medicare. OptumRX administers my prescriptions for my state plan.
My set up seems a little different than yours. Maybe the different plan? On my Optum RX benefits and claims page you can find quantity and date filled (not delivered). Under order status where it says delivered it shows the date it was delivered. Under payment methods, under the card on file, you supposedly can delete your card. I have never tried so I don’t know if it actually deletes it. You can add a different card if you want. Somewhere else is the autofill option, I’ve used it, but all my scripts need a new script right now so it isn’t showing.
Under my prescriptions, For the single scripts I got at the local retail pharmacy, it lists the ones I got and there the information is sparse. It will just say 7 day supply and the cost.
My delivered shows the date of delivery right under it.
Almost everything can be autofilled, but for some reason certain things can’t. Like my pods I have to call every 90 days. You can call a month early to set it up to be filled though. I had my Humalog on autofill and built up too much, so I turned off the auto fill option on their website and now I call when I want it. Maybe they accidentally have sent some stopped autofills to some people, but I have never had that problem when I have stopped an autofill. That’s just me, as I said others could have had a different experience.
I have never had a problem with them transferring a prescription, it just takes a couple of days sometimes. I did that when I realized I would be charged a 2 month supply for one inhaler. I also did that on an Afrezza prescription because Optum was going to be out of it for a week or two. I then transferred it back the next month.
I have a set copay, I always have on a tier system, so that experience might vary with the plan you have. For me, Optum Rx at mail order is a 3 month supply and a 2 month charge. I am usually better off in the case of a one time purchase or a month supply getting it from my local pharmacy (it’s still through insurance). No matter whether I get a 1 month, two or 3 month supply I will get billed for the 3 month supply, 2 month charge through Optum mail order. So if say I want one inhaler, I am better off going to the local pharmacy because at the local pharmacy I will get charged the one single script insurance price. Through mail order Optum I will get charged the 3 month supply/2 month charge for 1 inhaler. No matter if I get 1 or 20 as a month supply written by my doctor, it will be that 2 month charge.
I always immediately when I call, keep saying associate, help, customer service, representative and go straight to a live person. The computer has never been very helpful when I’ve had to call.
But that is how my plan is set up… yours could vary. I’m not trying to say your experience had those issues, I’m just saying mine has been different.
@Marie20 – Thanks for taking the time to describe your much different experience with Optum Rx. One thing that this thread reinforces is the idea that the U.S.insurance and the medical system is complicated, maybe needlessly so. Is the complexity a way for the insurance plans to be more profitable?
It’s easy to lapse into a cynical attitude (my tendency!) but staying pragmatic, like you seem to have accomplished, is definitely more useful.
Like the Wizard of Oz and Toto pulling aside the curtain revealing a man operating levers that create the illusion of the Wizard. Toto never would have reached the wizard without everyone else. It all sounds terrible when putting it together in one place but it is not that bad. I trust OptumRx to deliver the medications I need to stay alive. If the website experience is really important to you PM me and we can do a Zoom call and I’ll screenshare the site.
@Marie20 Calpers? You are describing the same setup that I’m looking at, we are just looking for different things. The prescription expiration date used to be on the prescription info page but it got removed in the last site redesign. The info is on the pharmacy label once the medication arrives. I only have to track it because my Endo doesn’t do anything to track prescriptions. Hopefully Terry has a better doc. Regarding credit cards, I have removed my credit card via the web site. The phone reps still ask if I want to use “the card on file” and name the last 4 digits of my card. And for autofill, yes you can turn it off per prescription but once your doc sends in another prescription, even for the same medication, their system’s default action adds the prescription to autofill. A customer can opt out by calling in but the note method creates the opportunity for errors.
I think the expiration isn’t there because I get items, like the boxes of humalog or pods with different expiration dates.
I agree with spdif, Optum is both pharmacy benefit manager and pharmacy. That is a conflict of interest. They do use prior authorizations. There may be a protracted delay, but generally the authorization goes through.
I am not on Medicare.
Apart from these concerns, they have been fine for the best 20-odd years.
I’ve had a good experience with express scripts and currently Optimrx . No issues
I get my insulin, needles, and several pills every 90 days through Optum RX, because (I’m guessing like you) my plan is through Cigna and I can only get 30-days supply through other pharmacies.
It works well for me. Insulin comes well packed with freezer packs via overnight. Other prescriptions come via USPS (although occasionally they are thrown in with the insulin packs if the calendar lines up right).
I can refill the 90-day prescription as early as around 80 days.
Thank-you for all the feedback on Optum Rx. I’ll be selecting my Medicare Part D Rx plan for 2024 in the next few weeks. The mail order pharmacy is one factor in the larger decision.
Does anyone know of a source that posts reviews about the various mail order pharmacy firms (aka pharmacy benefit managers or PBMs)? I’ve had first hand experience with Caremark and Express Scripts but years have gone by and things may have changed.
Medicare has “star ratings” (1-5) of the various plans but no ratings on the PBMs. I have an appointment with a SHIBA (state health insurance benefits assistance) counselor in a few weeks. (Every state has a SHIBA program.) I’m doing all the research now and hopefully the counselor confirms my tentative choice.
Medicare open enrollment started today, October 15, and ends December 7th.
Terry,
I am also ready to choose Medicare Part D for 2024. I currently have a Cigna plan which continues to increase premiums and cover less. I am just curious regarding what you are currently paying for your plan and what premium range you expect for 2024. I know it will depend upon our personal medication lists. I expect to change to a different plan entirely for 2024.
Jane
Jane - One thing I’ve learned about the cost of a Medicare Part D Rx plan is that you need to compare the total cost of the plan before deciding which plan is best for you. Medicare.gov includes the monthly premium + the deductible + the out of pocket costs of all the drugs you expect to take for the entire year before you can make a rational decision. The monthly premium is only one factor in the cost.
Having said all that, I can tell you that for 2023 I have used a Cigna plan as well (Cigna Saver Rx (PDP) Plan ID: S5617-380-0). My monthly premium is $12.33. Unfortunately, I needed to add a very expensive drug shortly after I started the plan year. It made my cost a lot more but at least the mail order portion of the Cigna coverage made the cost of the drug feasible.
The above Cigna plan has already indicated that it will not cover this medication, at all for 2024. I must switch to another plan. I have my eyes on two or three other plans but will run those by the Shiba counselor that I meet within a few weeks first. The monthly premiums range from $0 to about $80 per month.
