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Re: What Medicare.gov says about Using Your Drug Plan - Auto Refills

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Message 11 of 126

Medicare.gov - Automatic refill mail-order service for prescription drugs 

 

from the link ~

 

Some people with Medicare get their prescription drugs by using an “automatic refill” service that automatically delivers prescription drugs when you’re about to run out. In the past, some prescription drug plans weren’t making sure that some customers still wanted or needed a prescription drug and this created waste and unnecessary additional costs for people with Medicare and Medicare prescription drug coverage (Part D).

 

Now, plans have to get your approval to deliver a prescription (new or refill) unless you ask for the refill or request the new prescription. Some plans may ask you for your approval every year so that they can send you all new prescriptions without asking you before each delivery. Other plans may ask you before each delivery.

 

This policy won’t affect refill reminder programs where you go in person to pick up the prescription, and it won’t apply to long-term care pharmacies that give out and deliver prescription drugs. Giving your approval may be a change for you if you've always used mail-order in the past and haven't had the opportunity to confirm that you still need refills.

 

. . . .  Contact your plan if you get any unwanted prescription drugs through an automated delivery program.  You may be eligible for a refund for the amount you were charged. If you aren’t able to resolve the issue with the plan or wish to file a complaint, call us at

1-800-MEDICARE (1-800-633-4227).

 

more at the Medicare.gov link above.

 

More info for you -

National Law Review: 06/06/2018 - The Hazards of Prescription Auto-Refill Programs 

 

from the NLR link above:

States may be starting to take aim at prescription automatic refill programs. Automatic refill programs have been proven to increase patient adherence, especially among patients with chronic conditions. However, these programs are not popular among regulators: Medicare Part D and several state boards of pharmacy have prohibited these programs for mail order pharmacies and an increasing number of state Medicaid programs are prohibiting automatic refill programs for both mail and retail pharmacies. Regulators argue that automatic refill programs result in waste to the system, stockpiling, and federal program payment for unneeded prescriptions.

 

more at the link above ~


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Optum RX - STAY AWAY

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Message 12 of 126

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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Re: Optum RX - STAY AWAY

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Message 13 of 126

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

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Re: Optum RX - STAY AWAY

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Message 14 of 126
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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Re: Optum RX - STAY AWAY

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Message 15 of 126

@somarco wrote:

@GailL1 this thread is over 2 years old and 100+ opinions.

 

Opinions are just like navels. Everyone has one and everybody thinks theirs is right.

 

The good thing about drug plans is this. If you don't like the plan you have change it during the next open enrollment. No one is FORCED to keep their plan year after year. There is no underwriting. No artificial barriers to changing the plan.

 

We have been through 2 open enrollment periods since this thread began and I see the same complaints, sometimes from the same people.

 

If someone felt wronged by Optum in 2018 and they are STILL using that drug plan then one has to wonder WHY they are still finding fault with Optum and unwilling to initiate a change.

 

There are 29 drug plans in my area. In the 4 years I have been on Medicare I have had 3 different plans. It's not a big deal to change.

 

But I guess some folks would rather complain.

 

Rant off/


My suggestion about complaining to Medicare about a Medicare drug plan (or drug plan embedded in a Medicare health plan) is so that it will be noted for the Medicare star rating system - you do know that there is a monitary rewards for those insurers who get a 4- or 5-stars.

 

I find it odd,  all these (Medicare) complaints about Optum since they have a big foot print in many other (state and federal) public funded system and employer private systems as the contracted processing agent.

 

Somehow I wonder if people who are making some of the complaints here have reviewed their Evidence of Coverage, including the Formulary, procedures for the online ordering, pharmacy networks and understand this insurers system which should be spelled out specifically in the document and is updated annually(calendar year) with periodic updates during the year on specific medications.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Optum RX - STAY AWAY

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Message 16 of 126

@m702796s .I think AARP gets such a kickback for having their name attached to this Medicare plan and getting so many new enrollees for UHC

 

Of COURSE they earn a "kickback" for promoting products, INCLUDING those from UHC. Those revenues go to a subsidiary (AARP Services).

 

AARP Services is a wholly owned taxable subsidiary of AARP and provides quality control on behalf of AARP for AARP-branded products. Through the branded products of our service providers, we make available new and better choices to our members. Among these are health and financial products, travel and leisure offerings, and life event services.

 

Fiscal year 2018 showed $299,865,000 in dues revenue and $1,648,795,000 in TOTAL revenues. $938,892,000 came from "royalties" which include "kickbacks" from insurance products.

https://www.aarp.org/content/dam/aarp/about_aarp/annual_reports/2019/2018-audited-financial-statemen...


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Re: Optum RX - STAY AWAY

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Message 17 of 126

41 MA/MAPD plans in my area including 7 who do not have a drug plan paired with their MA plan. Five different carriers INCLUDING UHC offer MA without requiring a drug plan.

 

All MA/MAPD plans are "off the shelf, one-size-fits-all" coverage. 

 

If you don't like what's on the menu, go somewhere else. 

 

Or you can complain even though it accomplishes nothing but makes you feel better.


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Re: Optum RX - STAY AWAY

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Message 18 of 126

Opinions are just like navels. Everyone has one and everybody thinks theirs is right.

 

The good thing about drug plans is this. If you don't like the plan you have change it during the next open enrollment. No one is FORCED to keep their plan year after year.

 

EXCEPT...with this AARP Medicare Advantage plan with UHC, YOU CAN'T CHANGE DRUG PLANS.  Do your research before you offer yet one more opinion. With AARP UHC Medicare Complete advantage plan, the drug plan is attached. AND IT HAS TO BE OptumRX and it is so incredibly bad as to be almost criminal. That's why people are angry. The insurance plan is excellent. It's hard to get anything as good. But the drug plan which has to come with it, is horrible. And you can't opt for another drug plan.  No one can figure out why AARP doesn't do anything to circumvent the problem. So they write in the forum hoping to persuade someone to pay attention or to find ways around the ineptitude that is OPTUMRX.

One more opinion here, so be ready....I think AARP gets such a kickback for having their name attached to this Medicare plan and getting so many new enrollees for UHC, that they choose not to care about the drug plan. It's the only answer that works. It's beneficial for the organization that is AARP and they sold out their constituents for the $$$ they get from UHC.

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Re: Optum RX - STAY AWAY

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Message 19 of 126

I have Optum through a UHC Advantage plan, not as a part of a separate drug plan.  In my area there are only three Advantage plan providers, Aetna/CVS, BCBS and UHC.  The Aetna plans are only two years old including this year so there is little to no feedback on them.  That leaves BCBS which is much more expensive across the board on everything and provides less benefits outside of prescription coverage which seems to be mandated by Medicare on advantage plans).

 

My single complaint is that Optum does not provide an English as a 1st language customer service option. It is not unreasonable to expect customer service especially for a US Government mandated service be manned by representatives that speak and understand English.  Medicare provides information ad nauseum about how people who do not speak English must be catered to - something I take no issue with - but they seem to have left the majority in limbo on that.  UHC has US based call centers that you can request when someone answers the phone and you hear their poor English right away - Optum does not.

 

In order to use a retail pharmacy through UHC my costs apparently would triple.

 

I do not have '29 different plans' to choose from.  I suppose if someone had a deficient reasoning process they might assume that their circumstances applied across the board to every single person on the planet.

 

 

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Re: Optum RX - STAY AWAY

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Message 20 of 126

@GailL1 this thread is over 2 years old and 100+ opinions.

 

Opinions are just like navels. Everyone has one and everybody thinks theirs is right.

 

The good thing about drug plans is this. If you don't like the plan you have change it during the next open enrollment. No one is FORCED to keep their plan year after year. There is no underwriting. No artificial barriers to changing the plan.

 

We have been through 2 open enrollment periods since this thread began and I see the same complaints, sometimes from the same people.

 

If someone felt wronged by Optum in 2018 and they are STILL using that drug plan then one has to wonder WHY they are still finding fault with Optum and unwilling to initiate a change.

 

There are 29 drug plans in my area. In the 4 years I have been on Medicare I have had 3 different plans. It's not a big deal to change.

 

But I guess some folks would rather complain.

 

Rant off/


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