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Periodic Contributor

Optum RX - STAY AWAY

If you go to a pharmacy and they hand you a prescription then tell you it cost $160, you have the choice of handing it back.  NOT WITH OPTUM RX.  Website said no co-pay.  Prescription recieved then credit card bill arrives with $160 charge.  Called Optum RX.  They will not accept any return nor issue any refund.  Called Regions Bank to dispute charge.  They refused to accept dispute but charge penalties and interest while reviewing my case and reported a late payment to credit bureaus.  The whole experience has been BAD!!!

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Super Contributor

It's ironic that I was emailed this thread since I only just realized that my prescription has gone up on every refill. I am trying to transfer it to CVS, which is half the price. OptumRx wanted over $15! I used to get it a few years ago for $4! After reading all these reviews, I'm going to call them right now and make sure they transferred my prescription. My other prescription price has stayed the same and is cheaper than other pharmacies, so I'll keep that with OptumRx, but I'll be sure to keep an eye on it.

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Newbie

After quoting my insurance agent one price for a particular medication, once ordered, the price doubled and upon renewal would have put me into the Donut Hole! They are charging twice what CVS is charging and THREE TIMES what Rite Aid is charging. Attempts to get this issue addressed through the filing of "Escalation" letters led to weeks of no response despite multiple calls by myself and my agent who then found out they closed the case without ever speaking to either of us. This is going to cost me hundreds of dollars for no other reason but OptumRx misrepresented the price of one of my key medications. They are a disgraceful and shameless company who do not deserve anyone's business. BTW, AARP constantly pushes advertising for UCH and, therefore OptumRx, but attempts to get them to advocate for a 19 year AARP Member were completely ignored.

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Contributor

There is no question that Optum is a behemoth participating in making our terrible national health system as bad as it is, by squeezing consumers as much as possible.

 

I had nothing but double-talk from them when I contacted them about other issues.

 

Here's something I found by accident while navigating the horror of drug pricing: GoodRx is very, very chummy with Optum, the pharmacy benefits octopus that owns many of the so-called drug discount cards, meaning Optum negotiates so-called discounts with itself via these cards.

 

(If you look at GoodRx’s business fillings for GDRX, the SEC had some questions about it’s relationship with Optum, which is one of the 3 main pharmacy benefits managers forming the base of GoodRx’s business model.)

 

I happened to phone the customer service number on an old GoodRx card -- 888 277 3911 -- and an Optum representative answered the phone. I verified that he was at Optum, and not their discount card department, either. He said he didn't know anything about GoodRx (or discounts on drugs).

 

How odd that Optum would coincidentally end up with an old customer service number that had been used by GoodRx.

 

Very possible Optum's tentacles have swallowed up GoodRx, too, and both companies are so slimy they're hiding it.

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Newbie

I wish I had read this topic before switching from a UHC/AARP Medicare Supplemental Plan to the Medicare Advantage plan. I had CVS for mail order for prescriptions on that plan and they never screwed up once. They filled every prescription quickly and accurately. My spouse switched over to a Humana medicare advantage plan last year and it worked well for her. After we moved to Florida from Colorado last year my UHC/AARP monthly premium increased over $50 per month so I switched to the UHC Advantage plan during the open enrollment period.

 

The first thing I found was that my prescriptions with refills could not be transferred over from CVS to Optum Rx. So I scheduled and appointment with my new primary care physician and gave him a  list 6 prescriptions to send to Optum Rx. After not hearing anything for several weeks I called the doctors office and they said "Oh you wanted us to send those in?" to which I replied  "Well yes,that is why I supplied you with a complete typewritten list of my prescription medications". D'oh!. So they sent in the order to Optum Rx and I received 5 of them fairly quickly from Optum Rx.

 

The 6th was a generic formulation for Exforge blood pressure medication. I have been taking this for at least 10 years and never had a problem getting it. Without going into gory details I have been round and round with Optum Rx who claimed it was out of stock and they don't have a freakin' clue when it will be in stock. I have been given shipping dates that later disappear on the web site. Yesterday the order just disappeared from the web site as if it never existed.

 

When I called and yelled at the first CSR after getting the same nonsense out of stock answer I got to a lead person (also ESL) who talked to several people and then suggested they could contact my doctor and get 3 prescriptions for the components of Exforge. That's where it stand now. They kept offering the option of filling it locally which is fine except for the $30 copay out of my pocket. Why should I pay to fill it locally when they are a national pharmacy?

 

I wrote a long complaint to UHC on their secure message thing yesterday. I told them that my experience with Optum Rx would cause me to look at other plans.

 

BTW, the secure message system on the Optum Rx web site had been broken until today. I hope my complaint had something to do with getting it fixed bu who knows.

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Regular Contributor

I hear ya, Susan. My supplemental plan went up, too but not $50. I don’t know if it’s too late to switch back and I live in CA but I can’t deal with any of that anymore. I have a separate Medicare-D with express scripts that I pay about $30 a month for and the AARP UHC is about $150 which only went up about $7. Insurance is so expensive along with Medicare premiums but I really think you get what you pay for sometimes. It’s sad but true and I can’t really afford it but I have some serious pre existing medical problems and I refuse to deal with HMO’s as I know what they are. I get some of my Rx from Walgreens, CVS and you can also pay out of pocket at Costco and not use insurance. They are often cheaper than using your insurance! One of my meds, with insurance was over $500 at Walgreens’s and $45 cash at Costco. You don’t have to be a member either! 
Good luck with everything. I’m not answering emails about Optum anymore because I can’t deal with their BS but I saw yours and decided to reply. 

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Bronze Conversationalist

@JazzGirl9 California has the "birthday rule" for Medigap plans. Ask your agent how this works.


Bark less. Wag more.
Regular Contributor

All of the Medicare Advantage Plans Stink. It's pick your Poison. I've had many. Not much difference. Their CSR's have not got a clue. You try to speak to someone with knowledge on Your question, and they throw up a smokescreen. They open the same book You have, and recite word for word, what You already know. Medicare Advantage Companies are a Multi Billion dollar industry. They could not care less about us Seniors.  It's all about the Benjamin's.

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Bronze Conversationalist

An experienced agent can be more helpful than the folks who work for a carrier or General Dynamics (Medicare "customer service")


Bark less. Wag more.
Newbie

I am being charged $600 when the price at Walmart for the same item without insurance is $36. Had Drs office contact optum twice now without response.

 

Best plan seems to be switching to different company asap. Filed complaint with Medicare, bbb, consumer affairs., and bank of america.  Maybe there using the current pandemic situation to steal from seniors. Could be possible.

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Super Contributor

Did you try calling them? They've always been helpful for me over the phone. Did your doctor not allow generics on the prescription? Other options are ordering from Canada or buying in Mexico if you live near the border. Also, I always confirm the copay before ordering on the phone.

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Honored Social Butterfly


@p243396w wrote:

I am being charged $600 when the price at Walmart for the same item without insurance is $36. Had Drs office contact optum twice now without response.

 

Best plan seems to be switching to different company asap. Filed complaint with Medicare, bbb, consumer affairs., and bank of america.  Maybe there using the current pandemic situation to steal from seniors. Could be possible.


Every insurer negotiates their own prices on different drugs.  Medicare dictates via law which different classifications of drugs they have to carry on their formulary and how many of a certain type.  You have the right to chose the insurance that is best for your needs - including which meds and their cost.  You have the right to change a Medicare Part D plan or a Medicare Advantage Plan with or without a built-in drug plan every year during open enrollment.

 

But, if you are correct in your price check on this medication, then why not just buy it at Walmart without using your insurance.  You might even check GOOD RX to see if you can find an even cheaper price.  How Good Rx Works

 

You are mandated by Medicare to have drug coverage or face a premium penalty if you ever need the coverage.  But they don't mandate that you have to use it. 

 

Insurance is a share and share alike instrument - you pay your premium not just for yourself and your coverage but to also share with others to help them cover themselves and their needs. 

It's Always Something . . . . Roseanna Roseannadanna
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Newbie

Someone tried to sign me on to Optium RX or they're fishing.

 

First I got an autocall where I just had to say YES to join -- I hung up.

Then I got an email asking me to auto-reply -- didn't reply

 

Stay Away doesn't describe the above.

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Periodic Contributor

I was able to call United Health Care/Optum RX and opt out of home delivery.  This allowed me to use a local pharmacy.  

 

A local pharmacy that is able to fill my prescriptions in a timely manner and correctly!  

 

The number I called 1-866-236 1495

 

Hope this helps!

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Regular Contributor


@RayAnita1981 wrote:

I was able to call United Health Care/Optum RX and opt out of home delivery.  This allowed me to use a local pharmacy.  

 

A local pharmacy that is able to fill my prescriptions in a timely manner and correctly!  

 

The number I called 1-866-236 1495

 

Hope this helps!


Can you order a 90 day script through the local pharmacy at the same cost or rather what is the cost difference?

 

I have been to my local CVS who told me yes they would fill a 90 day script yet the UHC site states you cannot fill a 90 day script through a local pharmacy though that may mean there are charges for 3 30 day scripts rather than 1 charge for a 90 day script.  UHC implies my costs would be 3 times as much to walk to my local CVS. Once a CVS clerk looked up a script for me based on my plan and said the charges would be the same but on every other occasion I have asked they have always said that I would have to actually have a script to them in the system in order to get a correct answer.

 

I could also get three different answers on that from 3 different reps so the opportunity to get an answer from someone who is actually doing it is pure gold - thank you in advance for any info you can impart.

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Periodic Contributor

My insurnace is United Healthcare, through my spouse's employer. OptumRx is a division of United Healthcare.  That is why they push (to put it nicely) people to have their RX filled through OptumRX.  

 

United Healhcare will not allow Walgreens to fill my prescription that is WRITTEN for 90 days, to be filled for 90 days.  30 days is max allowed.     

 

The same medicine, when my insurace was Blue Cross Blue Shield, was 20.73 for 90 days when filled at a Safeway pharmacy.

I now pay a little more then $20 for a 30 day supply.

 

Hard to say if the difference in price is due to me changing insurance companies, if medicine went up in price over the last few months, if the one pharmacy is more expensive then another, if I am being "punished" for not going with Optum Rx, or a combination of factors.  (I lean towards United Healthcare is punishing me.) 

 

At this point, it is worth it to me to pay more (for this particular medicine) to NOT have to deal with OptumRx!  

 

Maybe they only increase the price for certain meds?  I have a VERY expensive RX coming up.  I hope to find out this week IF Walgreens can fill it (it is a speciality medicine) and how much it will be through them.  If I remember 🙂 I will post what I find out. 

 

 

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Newbie

I have United Healthcare Medicare Advantage also.  Three of my drugs are 90 day and I can only use Optimum for 90 refills.  If I go through CVS or Walgreens, I must make 3 co-pays.  Virtually every time I need to get a refill, there is a problem with Optum RX.  I've never once had a prescription filled with them without either a run-around or a problem occurring.  You often get contradictory explanations depending on whom you speak to.  They also show little or no concern that your drug has not been filled and never follow up with you.  Horrible!  

Newbie

I am having similar problems with OptimRX.  The have told me they issued a refund check, but it never came.  I went through their messaging center on line. And they first told me they couldn't reverse the charge and put the money back into my checking account, that they would have to issue a check, that never came.  I have called them about 10 times, and have 20 messages.  They still have my money.  I will NEVER recommend them again.  In fact I may even change my  health care to a different company than AARP Complete/United Health Care.  Senior citizens don't need this kind of frustration.

Periodic Contributor

Report them to Medicare and if you are in CA report to dept of insurance fraud division

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Periodic Contributor

FOLKS....

 

PLEASE start contacting Medicare to report both OptumRx and your Healthcare plan if it's provided through your advantage type.  Also report AARP UHC to Medicare.

 

This is the ONLY way it will be rectified. This could be considered fraud because people aren't receiving their money.

Honored Social Butterfly

@aw6946 

🏆

Let's Make it Easy -

Medicare.gov - Medicare Complaint Form 

 

High star-ratings should not be given to companies that don't perform well.  Part of their payment from Medicare is based on their star-rating.

 

You can also vote with your feet - you can switch to another Medicare Advantage plan, a Medicare Prescription Drug Plan, or a combination Medicare Advantage Plan with an included Prescription Drug Plan during Open Enrollment in the Fall each year.

 

It's Always Something . . . . Roseanna Roseannadanna
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Newbie

I agree that Optumrx is a terrible company! I have had nothing but headaches dealing with this company and their denial of coverage even when you jump through all of their

hoops ! 

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Regular Contributor

Thank you, actual feedback such as this is much appreciated.

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Contributor

Thank you for providing phone number.  
Why AARP is still using them ( rather tha BRIOVA) is beyond me.  

I know your calm information will help a lot of people!

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Periodic Contributor

Briova is no more.  They are now OptumRX.  😞

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Newbie

I'm very tired of the lies from Optum RX.  I would love to see them go out of business they are so furstrating and hold no intergerity with me. 
My prescription doen't cost me a thing, but they will not allow me to use their automated system unless I give them a credit card.  But when I talk to someone, they give me the prescription without asking for a credit card.
I've had my credit card number has stolen before.  If there is no charge, why do they require it?  And then later send me the prescription without any credit card number? 
This issue happens every 3 months and every three months they say they will notify management.  But nothing changes.  I don't trust them with my credit card number and it's not needed.  So why do they want it? 
AARP needs to get rid of Optum RX

Periodic Contributor

My MAIN issue was the credit card situation.  IF you agree to have it put in system, they AUTOMATICALLY send Rxs to you without your consent. They refer to the agree of ToS. THEY DON'T CARE. Then all the reps cared about was citing and reading their policy. Then it would meet their "liability/ EOC, .." standards, rules,.. and it was ON a recording for appeals or court action.

 

Even when I repeatedly asked to be transferred to the next level. The rep refused. It's what the rep has been trained to do bc I know how shady call centers can operate when they want to prohibit further complaints,... Were I worked DID NOT operate that way. FOLKS, I had many years in industry.

 

But in order for me to receive my Rx, I had to give them my credit card. Then they KEPT IT IN THEIR SYSTEM! SO, guess what, then they'd start the cycle over again.  Only way to hopefully stop cycle, was to call later AFTER ALL WAS PROCESSED, couple days, to have credit card removed.

 

You could NOT remove the card via the computer/online. Had to call back and SPEAK to someone.

 

So you tell me folks who think that I just want to complain, or don't know what I am taking about, how would you resolve?

 

I finally left at Open Enrollment. I also called their marketing team to let them know.

 

**********OTHERS: FILE WITH MEDICARE PER WEBSITE.  but by my time, it wasn't worth it bc I was switching. But I had option to switch.**********

 

UHC doesn't care unless the liability would be too great. AARP has become a data collection [via their tax program to now "ask" for your info to be shared with others who might have programs your interested in. No they don't share your personal tax info. The upper echelon paid ppl don't care.

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Periodic Contributor

Excuse me, but I used to manage member services and was well versed in EOC, SPD, EOBs, etc. I managed call center teams, etc. Knew HMO, Medicare, PPO, POS, etc.
 
I set up group benefit plans. Worked for fully integrated delivery systems. Carve-out behavioral health, worked for the largest BHC in the nation as well as smaller models. 
 
Additionally, I also for the accreditation agency for hospitals, etc. My father taught MPH, MHA, biostats, etc. He created a GLOBAL independent study program over SIXTY years ago that were for COUNTRIES too. I've worked in a multitude of different systems, HC related and not.
 
Thus, now that we've established ingame some level of understanding, let me state your opinion was .... very condescending.
 
Obviously, you don't know me. When I call and have issues and know HOW these systems operate, can speak the language, and can't get matters resolved, then I think, geez how the the *%_=! does someone understand complex systems like this [or taxes, or underwriting, or ... BTW I understand those too].
 
If your intent was to be helpful it wasn't. NO you CANNOT change the PBM /RX for ALL plans. These also vary based on state laws even though Medicare is a FEDERAL program.
 
Yes, I could and I did. 
 
Yes, I understand most don't read EOC / SPD ..   Yes, I believe nearly everyone needs to take on more accountability in life. Yes, also learn. 
 
But as a person that has had to read legal contracts, RFPs, 400 PAGE SPDs, which took TEAMS of individuals to understand, write plans,...  well, sigh.. 
 
EVEN understanding formularies that change, tiers, etc. And this info can change on an annual basis as well.
 
So, please, as Stephen Covey states,,,, 
 
***********   "Seek first to understand, then understood." **********
 
ALSO, there are individuals who don't use computers, have a complex Rx numerous prescriptions, might now even use the internet, etc. So please consider those skillset differences too.
 
FYI: The job posting for UHC the person to handle the PBM services.. customer interface, etc has been posted A FEW TIMES. In fact, it might even be open now. I'd encourage you to please look into that opportunity and help all the individuals who have these challenges. 
 
BTW, I even volunteered for AARP tax. They are a MARKETING company. 
 
Also, UHC will not do anything either. 
 
Thank you.
 
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Contributor

I am a pharmacist. This is the worst PBM (pharmacy benefits manager) I have worked with either professionally or as a patient. I was recently on the phone for 4.5 hours before the holidays trying to fix a mess up they made with not obtaining the right Rx, not shipping it correctly, and being transferred to 6 different departments and having to go thru their impossible to-get-off phone tree multiple times. At the end of the ordeal the problem was still never fixed. They refused to stay on the phone for 5 minutes to obtain a Prescripion from the transferring pharmacy even tho I was literally on the phone for hours trying to get the issue resolved. Luckily I joined late in the year and was able to switch insurance companies in time for the new year.  AARP should NOT be associated with this poorly managed company. Look up their BBB ratings.  It's not good and fits the poor reviews of this forum. I switched insurance companies specifically to avoid using their pharmacy service 

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Regular Contributor

Hi Cindoc95

So nice to hear this from a professional. Thank you for your input. We should complain to AARP. They could also be getting a big cut from Optum??? This is why I went with Express Scripts on my own. 

Nina

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