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Info Seeker

Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

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Message 1 of 13

OPTUM RX, no way, I just canceled them. They actually changed a dosage on my medications so they could charge twice as much. I asked for a refill on the cream and they had the dosage as half that of the real RX and it was expired.

However when I first ordered the cream with them, they offered three tubes for the price of two I would get at CVS. They ended up cutting the dosage in half and then I got one tube only for twice what I woud pay at CVS. I will never use them again. Trying to talk to them on the phone was a joke.

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Valued Social Butterfly

Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

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Message 2 of 13

@DaveS416939wrote:

. . . .  Every time I go for a script they need a prior authorization with a script in hand. I've never felt like an insurance company cares less than they do. 


It is all about controlling cost and they take their lead from the government, specifically CMS - how goes Medicare and Medicaid, so goes other insurance plans to save money.

 

Not saying this is right or wrong, it is just the way it is - with more government control, restrictions and regulations become paramount in controlling cost and that goes with whatever government level that is involved in controlling these cost - Federal or State.

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Valued Social Butterfly

Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

585 Views
Message 3 of 13

@DaveS416939wrote:

Their plan to cut down on opiods is just to refuse it to people that need it. Great plan


Oh, it is not just pharmacy plans doing it - the lead is coming from the government where regulation can be initiated - CDC, CMS

STAT News 03/06/2018 - Proposed limits to opioid prescriptions draws opposition from doc's, patients

 

The only way they know how to cut down on the abuse is to limit access and try other methods of pain control in many patients.  

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Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

592 Views
Message 4 of 13

Their plan to cut down on opiods is just to refuse it to people that need it. Great plan

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Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

596 Views
Message 5 of 13

I will be calling that number. Thank you. Everytime I go for a script they need a prior authorization with a script in hand. I've never felt like an insurance company cares less than they do. 

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Conversationalist

Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

795 Views
Message 6 of 13

So here's yesterday's episode in a nutshell.
I ordered Lynestra 2 weeks ago. 1 week later got recorded message,there will be 6-7 day delay. No problem,I had enough. Following week they leave message, they been trying to reach Dr. and haven't heard back. I ran out of medication that night. I called and told them if they would have left that message the first time I would of called Dr. to get on it. I thought it was a delivery or supply problem. Yesterday I called them to tell them I've ran out of med. been awake since 3:00 am having symptoms from stopping suddenly. They instruct me to call Dr. for an emergency 7 day refill. Dr. called in script to local pharmacy. Pharmacy called Optum rx twice. They were told by Optum ,they can't figure out how to do an over ride. The pharmacy called me, they can't spend anymore time on the phone with this Co. Remember, the pharm. has to make these calls to Optum all day for other customers with same issus's. They have a lot of customers that work for State of NJ that got stuck using Optum. I called Optum, spoke to Sup. I was given a # that only the pharmacy could call. They called 1 more time waiting on hold then told again by the 3rd person. Can't figure out how to do over ride. I called Optum 5 th,time and Sup, I explain the whole day's events and ask her why can't 3 people figure out how to do an over ride. She assured me they do know how and that she was gonna call the pharmacy and get this done by end of day. it's already 6:00 pm now. She said she would call me back to let me know it's completed. Never got a call back. The State of NJ need's to cancel this contract and go back to Express Scripts. But that probably won't happen, because it's all about saving money. The state doesn't care about it's employee's and their families. I'm sure Christie made some back door deal on his way out.
Follow the money trail.

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Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

821 Views
Message 7 of 13

I never thought I'd miss Express Scripts. Optum RX may be the most aggresively incompetent firm I've ever contacted. A medication previously covered "disappeared" from the formulary. What used to cost me $10 is going to cost $180+. But the medication isn't excluded on the online material provided by Optum RX. And when you use their search, they provide no alternatives. The only answer I could get is that they were told (by whom?) it's excluded. They insist there is no reduction in benefits. But if I can't get the medication I used to get, by definition that's a reduction. There was no reduction in our premium payment and this was not subject to negotiation. It's simply a theft. And when I tried to speak to someone else, I was placed on hold for 45 minutes (and my battery started to die). They are just awful. We collectively need to rise up and complain and change the pharmacy benefits manager to something/someone else. These people are hopeless.

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Valued Social Butterfly

Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

1,012 Views
Message 8 of 13

m573000l wrote:
Update; As of yesterday, I called again with my complaint. Purely coincidental I got transfered to the person that took my Dr's call Sat. When I went over my story he remembered it, and was man enough to tell me this. While working with another case,he accidentally terminated my script. I'm not gonna mention the young man's name, but I give him a lot of credit for admitting that. He got in touch with Prior Auth. and relayed story. An hour later I got recorded message that it's been approved.
God intervened.

Well, good for you.  Happy it all worked out.

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Valued Social Butterfly

Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

1,013 Views
Message 9 of 13

m573000l wrote:
I'm not on Medicare.
But why are mail order drug companies allowed to over ride The Dr.'s orders. Their the one's with an intimate relationship with the patient.

For several reasons and most of them are legislated or in place by a rule.

They are permitted to do it for:

1.  Health and safety reasons - 

2.  Cost

 

With the opioid problem, certain protocols have been put in place for further controlling the use of these type pain medications.  Doctors have prescribing rules for certain medications - especially those which have a medical use but are also a controlled substance under DEA enforcement.

 

1.  HEALTH and SAFETY:  The FDA approves drugs, they can also add safety measures, at the time of approval or even after other evidence comes to light.  They can also remove a med from the marketplace for safety reasons.

 

The CDC has authority over public health so they can also make rules in that arena on substances that are causing harm.

 

2.   COST:   Generics when approved as such are suppose to be the same in active ingredients as the brand.  So if a doc orders a brand drug, a pharmacist can fill the Rx with a generic if one is available.

 

If for some reason, the doc still wants the patient to get the brand, the doc usually has to file an exception for approval with the insurance company.

 

Certain meds also have various processes which discourage their use, usually because of cost, although some are also for health and safety.  These drugs may be classified for:

  • step therapy - a patient has to use another one to see if it works before getting the 1st ordered
  • quantity limitations
  • pre-approval

 

There is a lot of government control between you and your doctor.  There is also a lot of insurance control too.  Since your doc is a licensed professional, your doc has to play by the rules.

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Conversationalist

Re: OPTUM RX completely botched take over of prescription plan for State of NJ Employee's and Teach

1,019 Views
Message 10 of 13
Update; As of yesterday, I called again with my complaint. Purely coincidental I got transfered to the person that took my Dr's call Sat. When I went over my story he remembered it, and was man enough to tell me this. While working with another case,he accidentally terminated my script. I'm not gonna mention the young man's name, but I give him a lot of credit for admitting that. He got in touch with Prior Auth. and relayed story. An hour later I got recorded message that it's been approved.
God intervened.
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