Optum RX - STAY AWAY

[SarahH845050]

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!!!

[m155186b]

OPTUMRX has improved their service since starting.

[JohnV946481]

Horrible company! They have a copay card on file for a very expensive arthritis medicine. They admitted to forgetting to apply the copay card, and we got a credit card charge for almost $2000! They say that they will (I hope) fix it within 4 weeks. Meanwhile, we need to pay our credit card bill when it comes due. At the very least, if they make a $2000 error, they should fix it ASAP to avoid my having to deal with interest and late charges on the incorrect credit card charge.

[sherb50]

My experience with a hormone drug - $124 for 3 mo supply.  Called Wal-Mart - $50; called Costco - $50 - as a member $25.  I called them & told them & rep tried calling Wal-Mart to check herself but couldn't get through - I called again.. anyhow - no results - I disputed the charge on my credit card (Citibank).  I was credited the full amount & will now buy from Costco.. I know Medicare says we have to have a drug plan.  No, really, I don't.

[JerryS109]

I have been reasonably satisfied with OptumRx for the past 2 and a half years. I did run into a hiccup at my last Drs visit. He prescribed a drug and when I looked at the records for my Drs visit (before I left the office), I saw the drug cost $130. I said, "What??". When I told the office staff that I did not want to pay that much for the drug, they looked up GoodRx prices for me and gave me choices. They said that they could not cancel the OptumRx order, but that the Optum Rx order would cancel if they sent the same prescription to my local pharmacy. I said, "DO THAT". So now, what I have learned is, if my Dr says I need a new prescription, I ask him to NOT submit the order until I can verify the cost. Problem solved.

[Spring2023]

 3 comments (11/26/22) Hi @SarahH845050 , thank you for sharing your experience. So sorry you had to go through this! Any "updates" for us? I am "stressing out" already over signing up NEXT June 2023. Way too many problems with Optum RX. 😱Nicole 

[Spring2023]

(2 comments) I am in Virginia but read the complaints in this Public Group. Yikes, something needs to be done. Some of us are on "fixed incomes" and need our meds to stay alive. Me, blood pressure and chlolestral. Nicole 🙂

[j633226b]

I think I can help you re: cholesterol med. Short answer - no one needs a statin. Vitamin D3 provides the benefit. 
Proof: All statins lower cholesterol. All statins EXCEPT Crestor lower the rate of heart attacks. All statins RAISE D3 EXCEPT Crestor. Conclusion: Stop talking statins and take D3. Better yet, go outside in the sun. Most people’s D3 levels are determined by sun exposure because relatively few take D3 supplements. Sun exposure creates, destroys, up-repulates and down-regulates twenty different things. Creating D3 is only one of those things and is the only one measured. D3 alone is unlikely to be the sole cause of the benefits we see in people with higher D3 levels since most of them go out in the sun. The few doctors who are on the cutting edge of health research recommend one hour outside at solar noon each day. “But if I go in the sun I’ll get malignant melanoma.” First of all, MM does not correlate to sun exposure. What does correlate is a severe sunburn FOLLOWED BY SUN AVOIDANCE. The sun causes cancer AND IT CURES THEM. How do we know? Because construction workers have a lower rate of skin cancers than the overall population. The above is the only explanation for the above. 

[aruzinsky]

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@j633226b wrote:

... All statins EXCEPT Crestor lower the rate of heart attacks. ...

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Wrong.

https://www.reuters.com/article/us-heart-crestor/astrazenecas-crestor-cuts-deaths-and-heart-attacks-...

"The 17,802-patient study was stopped more than two years early by independent safety monitors because the benefit from 20 milligrams of Crestor daily was so pronounced -- 142 heart events with Crestor versus 251 on placebo."

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@j633226b wrote:

Better yet, go outside in the sun.

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Unless you live somewhere like Nevada, California, Hawaii or Florida, you can't get enough sun in the Winter to provide D3 because it is too cloudy and you have to cover yourself with clothing to protect yourself from cold.

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@j633226b wrote:

Most people’s D3 levels are determined by sun exposure because relatively few take D3 supplements.

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I doubt that that is true during the Winter because milk is fortified with D3, 2400 IU/gal, 

[drbad]

I'm sorry you had such bad experiences. I have been with OptumRx for several years and love it. I get Levothyroxine (for thyroid disorder) at NO COST (with Medicare and United HealthCare supplemental) so I could not be happier. 

[m155186b]

Well after 2 years OptumRX is working better.  I guess they just need time to get their act together.

[DennisF788680]

100% agree with "stay away."  Horrible, deceptive, money stealing organization.  These people took it upon themselves to contact my physician and ask her to write a new prescription for an old one that had expired.  They never informed me of what they were doing and the only reason I found out was because I got an email saying they were filling my prescription!  I called and managed to get it canceled but they then went to ANOTHER prescription ans asked my doctor for a new prescription, again without my knowledge!  Also, every time a prescription goes in they put it on automatic refill without informing me.  When I complained about this practice, their response was that they don't do it!!  They basically said I was a liar while they outright lied to me!  STAY AWAY!!!  

[hh1415]

  I completely agree with the Stay Away approach.  After my usual pharmacy decided to close I transferred a couple of prescriptions to OptumRx.  What a mistake.  Since they had a list of all my prescriptions they decided on their own to reorder the rest without my authorization.  I called, wrote, emailed, and messaged to cancel those.  On the sixth try they finally cancelled. 

 Using my law school knowledge, I looked up the laws.  There are no laws that I found that prevent pharmacies from attempting to refill a prescription.  There should be.  These people are hard to deal with and should be avoided.

[PinkyC958299]

Optum are money savers (For United Health Care) Not spenders. They manage claims and attempt to reduce them. Meaning that they DO NOT make money by increasing costs (Ordering more expensive items or increasing spending). That's not what they are in business for; They are trying to cut costs for United Health care and other insurance carriers who outsource their claims management service. DO NOT TALK TO THEM"

[GailL1]

Don't think it is a law but it is a pretty common procedure - some of the mail order fillers will opt a beneficiary IN automatically and then the beneficiary has to opt-out.  Just gotta read ALL that small print - no matter how small it gets (that's where we need a law !)

Medicare.gov - Using Your Drug Plan For the First Time

from the link:

Automatic refill mail-order service for prescription drugs

Some people with Medicare get their drugs through an “automatic refill” service that automatically delivers prescription drugs before they run out. To make sure you still need a prescription before they send you a refill, drug plans may offer a voluntary auto-ship program. Contact your plan for more information.

[fotogo3]

 I’ve never received an “automatic refill” until recently. I never approved it.  This is a new procedure with OptumRx. It’s simply a money generating scam. Funny that it’s the most expensive meds they send out. 

[GailL1]

@fotogo3 

What I wrote in my post of 11-07-2021 was from Medicare not OptumRx.

[hh1415]

Thanks for your response.  OptumRx didn't enroll me in an automatic refill.  The website shows the automatic refill option on each individual drug in the prescription list and no prescriptions are "checked".  They just took all the prescriptions I ever had and (re)ordered them.  They know the prescription list because they are related to the health insurance provider, Unitedhealth. They had asked about two of them when I talked with them at the time my requested order was place and I said "no, I don't need them".  They ordered it anyway.  This seems to me underhanded and unscrupulous even if it's not illegal. 

[GailL1]

You can always lodge a complaint about them with Medicare.

I have never worked with them directly but they do a tremendous amount of work for various government agency health plans like at the VA Community Care .

IN this thread there are several complaints like the one you made - Maybe  they do it to keep their STAR-Rating because "Getting Needed Prescription Drugs" is one of the measure areas for Part D plans - both free standing and MAPD.

Go figure ? !

[srk5cats]

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.

[chadjamft]

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.

[crabpaws]

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.

[SusanE71261]

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.

[ChrisH329340]

I'm having similar issues with Optum on my new AARP Medicare Advantage Plan. They keep switching my generic drug to brand name. I keep bothering my MD for new Rx. Round and round we go.... UHC states that if I don't use their Rx network I'll be punted from the Advantage Plan. This is looking better by the day.

I was happier being self-insured and paying $7.xx a month cash! 

[ChrisH329340]

Update - after much hooplah I was able to get the MD's office manager to re-issue the prescription, changing the 1.5 pills per day dosage to 1.0 pill per day. OptumRx filled it as promised, no charge for generic meds. I did switch OUT of the AARP UHC Medicare Advantage. My new plan also uses OptumRx but it is optional not mandatory. My med would cost less than $5 a month at the grocery store pharmacy I've been dealing with for 16 years. Small price to pay for less stress. I turned off auto-refill at OptumRx and am keeping my fingers crossed. Happy ending, but many new grey hairs and the MD's office hates me for "being so fussy" Well that's what a $4000.00 fuss looks like lady LOL. Wishing everyone luck on their journey.

[JazzGirl9]

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. 

[steve6354]

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.

[p243396w]

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.

[srk5cats]

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.

[GailL1]

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@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.

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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.