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Valued Social Butterfly

Re: optumRX

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Message 1 of 4

olearda1 wrote:

One of my wife's meds was also changed from Tier 1 to Tier 3. Another already a tier 3 now is a step drug requiring you to try a cheaper alternative before the brand name. Our doctor agrees the cheaper doesnt work. Hopefully I'll not have a problem when its time to order. I dont think a pharmacy or insurance company should be able to override your doctors orders.


Your Medicare D plan allows for an "Exception" which her doctor has to submit.

This should be covered in her plan details.

This is the CMS rule on it -

Center for Medicare and Medicaid Services (CMS) - Medicare Prescription Drug Appeals and Grievances ...

This gives an overview of how an "Exception" is initiated and processed.  If her doctor agrees that she should not have to "step" - he needs to take the appropriate action for his patient - sometimes it is all about the time it takes to do things according to the Medicare rules - rules that have been initiated to save the whole program some money because most of the time, the lower cost med works just fine.

 

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Re: optumRX

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Message 2 of 4

One of my wife's meds was also changed from Tier 1 to Tier 3. Another already a tier 3 now is a step drug requiring you to try a cheaper alternative before the brand name. Our doctor agrees the cheaper doesnt work. Hopefully I'll not have a problem when its time to order. I dont think a pharmacy or insurance company should be able to override your doctors orders. Optumrx is United Healthcares preferred pharmacy but I'm not required to use them. I will pay more but it's worth the extra to avoid the problems. I've used Caremark for over 5 years and never had a problem. I think AARP should read and act on some of these reviews since their name is on these Medicare Advantage plans

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Re: optumRX

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Message 3 of 4

As a retired teacher in the State of New Jersey we are being moved to Op tumRx as of January 1 2018.I have received correspondence that some of my prescriptions have been classified as tier 3 and will cost more.I have been given cheaper choices. This has also been done with my diabetic test meter and strips.One medication also has been classified as needing advanced permission and justification from the physician. I liked Express Scripts better.

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optumRX

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Message 4 of 4

As a new member I read about all te problems with OptumRX. Has AARP responded to any of the complaints?

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